Sabine Baron

Paediatric bone and joint infections are more common in boys and toddlers: a national epidemiology study

Little is known about bone and joint infections (BJIs) in children, despite the risk of growth disturbance. This study examined BJIs epidemiology using the French National Hospital Discharge Database (HD).

Quality Assessment of Hospital Discharge Database for Routine Surveillance of Hip and Knee Arthroplasty–Related Infections

OBJECTIVE Surgical site infection (SSI) surveillance represents a key method of nosocomial infection control programs worldwide. However, most SSI surveillance systems are considered to be poorly cost effective regarding human and economic resources required for data collection and patient follow up. This study aims to assess the efficacy of using hospital discharge databases (HDDs) as a routine surveillance system for detecting hip or knee arthroplasty-related infections (HKAIs). METHODS A case-control study was conducted among patients hospitalized in the Centre region of France between 2008 and 2010. HKAI cases were extracted from the HDD with various algorithms based on the International Classification of Diseases, Tenth Revision, and procedure codes. The control subjects were patients with hip or knee arthroplasty (HKA) without infection selected at random from the HDD during the study period. The gold standard was medical chart review. Sensitivity (Se), specificity (Spe), positive predictive value (PPV), and negative predictive value (NPV) were calculated to evaluate the efficacy of the surveillance system. RESULTS Among 18,265 hospital stays for HKA, corresponding to 17,388 patients, medical reports were checked for 1,010 hospital stays (989 patients). We identified 530 cases in total (incidence rate, 1% [95% confidence interval (CI), 0.4%-1.6%), and 333 cases were detected by routine surveillance. As compared with 480 controls, Se was 98%, Spe was 71%, PPV was 63%, and NPV was 99%. Using a more specific case definition, based on a sample of 681 hospital stays, Se was 97%, Spe was 95%, PPV was 87%, and NPV was 98%. CONCLUSIONS This study demonstrates the potential of HDD as a tool for routine SSI surveillance after low-risk surgery, under conditions of having an appropriate algorithm for selecting infections.

Clinical and economic outcomes of infective endocarditis

Abstract Background: In France, the estimated annual incidence of infective endocarditis (IE) is 33.8 cases per million residents. Valvular surgery is frequently undergone. We report an epidemiological and economic study of IE for 2007–2009 in a French region, using the hospital discharge database (HDD). Methods: The population studied concerned all the patients living in Centre region, France, hospitalized for IE. We extracted hospital stay data for IE from the regional HDD, with a definition based on IE-related diagnosis codes. The predictive positive value (PPV) and sensitivity (Se) of the definition were 87.4% and 90%, respectively, according to the Duke criteria (definite IE frequency 74.4%). Hospitalization costs were estimated, taking into account the fixed hospital charges of the diagnosis-related group (DRG) and supplementary charges due to intensive care unit (ICU) stay. Results: The analysis included 578 patients. The annual average incidence was 45.4 cases per million residents. Valvular surgery was performed in 19.4% of cases. The hospital mortality was 17.6%. Multivariate analysis identified as risk factors for mortality an age ≥ 70 years (odds ratio (OR) = 3.03, 95% confidence interval (CI) = 1.78–5.18), staphylococcal IE (OR = 3.3, 95% CI = 1.9–5.7), chronic renal insufficiency (OR = 2.04, 95% CI = 1.00–4.15), ischemic stroke (OR = 2.55, 95% CI = 1.19–5.47), and hemorrhagic stroke (OR = 5.7, 95% CI = 1.9–17.3). The average cost per episode was

Surgical Site Infection After Primary Hip and Knee Arthroplasty: A Cohort Study Using a Hospital Database.

20 103 (€15 281). Conclusions: We report a higher incidence of IE than described by the French national study of 2008. Valvular surgery was considerably less frequent than in the published data, whereas mortality was similar. IE generates substantial costs.

Échec du traitement de plasmodium falciparum par atovaquone-proguanil

BACKGROUND Hip or knee arthroplasty infection (HKAI) leads to heavy medical consequences even if rare. OBJECTIVE To assess the routine use of a hospital discharge detection algorithm of prosthetic joint infection as a novel additional tool for surveillance. METHODS A historic 5-year cohort study was built using a hospital database of people undergoing a first hip or knee arthroplasty in 1 French region (2.5 million inhabitants, 39 private and public hospitals): 32,678 patients with arthroplasty code plus corresponding prosthetic material code were tagged. HKAI occurrence was then tracked in the follow-up on the basis of a previously validated algorithm using International Statistical Classification of Disease, Tenth Revision, codes as well as the surgical procedures coded. HKAI density incidence was estimated during the follow-up (up to 4 years after surgery); risk factors were analyzed using Cox regression. RESULTS A total of 604 HKAI patients were identified: 1-year HKAI incidence was1.31%, and density incidence was 2.2/100 person-years in hip and 2.5/100 person-years in knee. HKAI occurred within the first 30 days after surgery for 30% but more than 1 year after replacement for 29%. Patients aged 75 years or older, male, or having liver diseases, alcohol abuse, or ulcer sore had higher risk of infection. The inpatient case fatality in HKAI patients was 11.4%. CONCLUSIONS The hospital database method used to measure occurrence and risk factors of prosthetic joint infection helped to survey HKAI and could optimize healthcare delivery.

Key features of bone and joint infections following the implementation of reference centers in France

Le paludisme est une parasitose érythrocytaire de distribution (sub-) tropicale. Cette protozoose, à l’origine d’environ 250 millions d’accès annuels dans le monde, est due à des protozoaires du genre Plasmodium. Le moustique anophèle joue le rôle de vecteur dans la transmission de la maladie. Nous rapportons le cas d’une récidive d’accès palustre à Plasmodium falciparum après traitement bien conduit par atovaquone-proguanil (AP).

G-07: Infection du site opératoire après arthroplastie de hanche ou du genou : une cohorte PMSI, 2008–2012

OBJECTIVES French reference centers for bone and joint infections (BJI) were implemented from 2009 onwards to improve the management of complex BJIs. This study compared BJI burden before and after the implementation of these reference centers. PATIENTS AND METHODS BJI hospital stays were selected from the 2008 and 2013 national hospital discharge database using a validated algorithm, adding the new complex BJI code created in 2011. Epidemiology and economic burden were assessed. RESULTS BJI prevalence increased in 2013 (70 vs. 54/100,000 in 2008). Characteristics of BJI remained similar between 2008 and 2013: septic arthritis (50%), increasing prevalence with age and sex, case fatality 5%, mean length of stay 17.5 days, rehospitalization 20%. However, device-associated BJIs increased (34 vs. 26%) as well as costs (€421 million vs. €259 in 2008). Similar device-associated BJI characteristics between 2008 and 2013 were: septic arthritis (70%), case fatality (3%), but with more hospitalizations in reference centers (34 vs. 30%) and a higher cost per stay. Among the 7% of coded complex BJIs, the mean length of stay was 22.2 days and mean cost was €11,960. CONCLUSIONS BJI prevalence highly increased in France. Complex BJI prevalence assessment is complicated by the absence of clinical consensus and probable undercoding. A validation of clinical case definition of complex BJI is required.

Support for the usefulness of passive postdischarge surveillance in surgical site infection.

Introduction – objectifs L’incidence de l’infection de prothese articulaire (IPOA) est une cible de la surveillance des infections nosocomiales, calcul difficile et peu robuste. L’objectif etait d’evaluer le PMSI, comme nouvel outil de surveillance des IPOA. Materiels et methodes Une cohorte regionale retrospective de patients avec premiere pose de PTH/G a ete construite (sejours avec acte de PTG/H + dispositif medical implantable), PMSI 2 008–11. Les sejours etaient lies aux patients par leur numero anonyme. L’IPOA etait detectee par un algorithme PMSI, precedemment valide par le controle de 1 000 dossiers medicaux dans 23 hopitaux de la region (Se 97 % Spe 95 % VPP 87 % VPN 98 %). Une analyse de survie a ete menee pour estimer les facteurs de risque d’IPOA et de deces (Cox). Resultats 32 678 patients avec pose de PTHG ont ete suivis au moins 12 mois ; 10 patients etaient perdus de vue. L’incidence etait a 2,3/100 pers-annees (603 IPOA dont 287 sur PTH), 2,2 pour la hanche et 2,5 pour le genou ; 30 % des IPOA survenait dans le premier mois apres la pose, mais 29 % apres un an. Staphyloccoccus sp . etait code dans 50 % des IPOA. La letalite etait a 11 %. L’analyse de survie identifiait les facteurs de risque d’IPOA : sexe masculin, presence d’ulceres, obesite ou denutrition, maladies hepatiques ou renales chroniques. L’IPOA, l’âge > 75 ans, la presence d’un cancer ou de maladies chroniques etaient des facteurs de risque de deces. Conclusion Le PMSI peut constituer un outil de surveillance en routine des IPOA en France, a moindre cout.