Surgical Site Infection

Surgical Site Infection: Challenge of the Coming Decade
by Javad Parvizi MD, FRCS

Hospital acquired infections continue to consume the largest portion of our healthcare budget and do result in immense morbidity and mortality1. The gravity of the situation is such that academic organizations such as the AAOS and regulatory bodies have hastily implemented measures to curb this devastating problem. The AAOS issued their guidelines for diagnosis of PJI that included many strong recommendations based on the available literature 2. The Center for Disease Control (CDC) is in the throes of revisiting the guidelines for prevention of surgical site infection (SSI). These guidelines are expected to be launched in the second half of 2013. The guidelines besides being evidence-based, will also have orthopedic surgery specific recommendations.

The gravity of SSI is also recognized by the scientific community seeking novel technologies to address this issue. Search for a molecular marker to diagnose periprosthetic joint infection (PJI) has lead to identification of Human Neutrophil Peptide (HNP) or alpha-defensin, as it is more commonly known (REF). It appears that the test carries extreme accuracy for diagnosis of PJI and we are within arm's reach of a lateral flow ELISA test (similar to pregnancy test) that can help diagnose this challenging problem with near absolute accuracy. There are numerous other developments including introduction of iodine based MRSA-decolonization agents, novel antibiotics, and silver impregnated prostheses 3 that are in clinical use in the UK and appear to reduce the incidence of PJI. Efforts are under way to attach natural peptides to the surface of prostheses that can prevent colonization and subsequent infection. The pharmaceutical industry is in search of novel antibiotics that can target cells riddled with infecting organisms. This may reduce the need for extended antibiotic therapy in patients with orthopedic infections. These promising technologies will be a welcome development for the medical community that seems to be heavily burdened with SSI.

REFERENCES

  1. Calfee DP. Crisis in hospital-acquired, healthcare-associated infections.Annu. Rev. Med.2012;63:359-371.
  2. Della Valle C, Parvizi J, Bauer TW, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on: the diagnosis of periprosthetic joint infections of the hip and knee.J Bone Joint Surg Am. 2011;93(14):1355-1357.
  3. Jeys LM, Grimer RJ, Carter SR, Tillman RM. Periprosthetic infection in patients treated for an orthopaedic oncological condition.J Bone Joint Surg Am. 2005;87(4):842-849.