504. Surgical Site Infections following Birmingham Hip Resurfacing
Session: Poster Abstract Session: Surgical Site Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA_SSI.pdf (144.8 kB)
  • Background: Hip resurfacing (HR) involves only partial resection of femoral head and is an alternative for total hip replacement (THR).  HR offers greater implant stability and easier future revision procedures. Birmingham hip resurfacing (BHR) is a type of HR procedure. Little is know about the incidence, epidemiology, and outcomes associated with surgical site infections (SSIs) following BHR. 

    Methods: A retrospective cohort study was conducted at Detroit Medical Center (an 8-hospital healthcare system). It included patients who underwent BHR from January 2006 to December 2012. Electronic medical records and infection control data was reviewed for patient data and infection 1 year following implant.

    Results: 967 patients underwent BHR within studied period. Mean age of the cohort was 55 ± 9 years, 647 (67%) were males and 465 (48%) were African Americans. 668 (69%) patients underwent BHR for degenerative joint diseases followed by 214 (22%) patients with avascular necrosis of hip. 729 (80%) patients received vancomycin and 177 (19%) received cefazolin for surgical prophylaxis. 6 patients developed SSI following the procedure (SSI rate=0.62%). Median time to SSIs was 25 days (IQR: 20-55). 4 (66%) developed superficial incisional SSIs, 1 (17%) deep incisional and 1 (17%) organ/space SSI.4 (67%) patients had purulent drainage from the surgical sites. 3 (50%) had methicillin resistant Staphylococcus aureus (MRSA), 2 (33%) had methicillin sensitive Staphylococcus aureus (MSSA) and 1 (17%) was culture negative. Pre surgical prophylaxis in all MSSA infections was found to be vancomycin, and in all MRSA infections was cefazolin. All patients were treated initially with incision and drainage (I&D) followed by IV antibiotics. Superficial incisional SSIs were successfully treated with antibiotics following I&D.  Patients with deep incisional and organ/space SSI required removal of hardware with a prolonged antibiotic course. Mortality at 1 year follow up was 0%. 

    Conclusion: BHR was associated with an SSI rate < 1%.  The majority of SSI were caused by SA predominantly MRSA.  All cases of superficial SSI were successfully managed with antibiotics and in cases of invasive SSI, with THR.

    Ashish Bhargava, MD1, Madiha Salim2, Harsha Vardhan Reddy Banavasi, MBBS3, Vijay Neelam3, Richmund Wenzel2, Sorabh Dhar, MD1 and Keith Kaye, MD, MPH, FIDSA, FSHEA4, (1)Detroit Medical Center (DMC) / Wayne State University, Detroit, MI, (2)Wayne State University, detroit, MI, (3)Wayne State University, Detroit, MI, (4)Infectious Diseases, Detroit Medical Center/ Wayne State University, Detroit, MI

    Disclosures:

    A. Bhargava, None

    M. Salim, None

    H. V. R. Banavasi, None

    V. Neelam, None

    R. Wenzel, None

    S. Dhar, None

    K. Kaye, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.