Proton-pump inhibitors are associated with increased risk of prosthetic joint infection in patients with total hip arthroplasty: a case-cohort study

Authors

  • Maarten M Bruin Department of Orthopedic Surgery, HagaZiekenhuis, Den Haag; Department of Orthopedic Surgery, LUMC, Leiden, The Netherlands
  • Ruud L M Deijkers Department of Orthopedic Surgery, HagaZiekenhuis, Den Haag
  • Roos Bazuin Department of Orthopedic Surgery, HagaZiekenhuis, Den Haag
  • Erika P M Elzakker Department of Medical Microbiology, Hagaziekenhuis, Den Haag
  • Bart G Pijls Department of Orthopedic Surgery, HagaZiekenhuis, Den Haag; Department of Orthopedic Surgery, LUMC, Leiden, The Netherlands

DOI:

https://doi.org/10.1080/17453674.2021.1920687

Abstract

Background and purpose — Proton-pump inhibitors (PPI) have previously been associated with an increased risk of infections such as community-acquired pneumonia, gastrointestinal infections and central nervous system infection. Therefore, we evaluated a possible association between proton-pump inhibitor use and prosthetic joint infection (PJI) in patients with total hip arthroplasty (THA), because they can be stopped perioperatively or switched to a less harmful alternative.

Patients and methods — A cohort of 5,512 primary THAs provided the base for a case-cohort design; cases were identified as patients with early-onset PJI. A weighted Cox proportional hazard regression model was used for the study design and to adjust for potential confounders.

Results — There were 75 patients diagnosed with PJI of whom 32 (43%) used PPIs perioperatively compared with 75 PPI users (25%) in the control group of 302 patients. The risk of PJI was 2.4 times higher (95% CI 1.4–4.0) for patients using PPI. This effect remained after correction for possible confounders.

Interpretation — The use of PPIs was associated with an increased risk of developing PJI after THA. Hence, the use of a PPI appears to be a modifiable risk factor for PJI.

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Published

2021-05-12

How to Cite

Bruin, M. M., Deijkers, R. L. M., Bazuin, R. ., Elzakker, E. P. M. ., & Pijls, B. G. (2021). Proton-pump inhibitors are associated with increased risk of prosthetic joint infection in patients with total hip arthroplasty: a case-cohort study. Acta Orthopaedica, 92(4), 431–435. https://doi.org/10.1080/17453674.2021.1920687