Inhaled Corticosteroids, Vitamin K Antagonists and Amlodipine Were Associated with an Increased Risk of Acute Periprosthetic Joint Infection in Patients with Total Hip Arthroplasty: A Retrospective Case–Cohort Study

Round 1

Reviewer 1 Report

PJI is one of the most serious complications following total joint arthroplasty. ICS were widely used in Asthma and COPD patients. Anticoagulants and cardiovascular drugs also extensively used in clinic. This manuscript by Bruin et al. addressed an increased risk of PJI associated with ICS, anticoagulants (VKA, PAI, DOAC), and cardiovascular drugs (amlodipine), which demonstrating a significant concern in clinical.

The analysis is based on large cases in the long period of time (8 years) which make the results solid.

Furthermore, this manuscript is well constructed. So, I suggested it can be published by the journal.

Minor points:

When referring to a bacterium in a paper, the writer should italicize the names in the text (I am not sure it is requested or not by the journal).

Line 271: complica-tions, replace with complications

Line 276: pa-tients, replace with patients

Line 280: compli-cations, replace with complications

Line 281: interna-tional, replace with international

Line 282: pa-tients, replace with patients

Line 290: periop-erative, replace with perioperative

Line 291: compli-cations, replace with complications

Line 295: misclassifica-tion, replace with misclassification

Line 297: con-servative, replace with conservative

Line 303: tempo-rarily, replace with temporarily

Author Response

Reviewer 1

PJI is one of the most serious complications following total joint arthroplasty. ICS were widely used in Asthma and COPD patients. Anticoagulants and cardiovascular drugs also extensively used in clinic. This manuscript by Bruin et al. addressed an increased risk of PJI associated with ICS, anticoagulants (VKA, PAI, DOAC), and cardiovascular drugs (amlodipine), which demonstrating a significant concern in clinical.

The analysis is based on large cases in the long period of time (8 years) which make the results solid.

Furthermore, this manuscript is well constructed. So, I suggested it can be published by the journal.

Response

Thank you for the thorough evaluation and helpful comments.

Comment 1.1:

When referring to a bacterium in a paper, the writer should italicize the names in the text (I am not sure it is requested or not by the journal).

Response 1.1

Thank you for your comments. We italicized the bacterium in our manuscript.

Comment 1.2:

Line 271: complica-tions, replace with complications

Line 276: pa-tients, replace with patients

Line 280: compli-cations, replace with complications

Line 281: interna-tional, replace with international

Line 282: pa-tients, replace with patients

Line 290: periop-erative, replace with perioperative

Line 291: compli-cations, replace with complications

Line 295: misclassifica-tion, replace with misclassification

Line 297: con-servative, replace with conservative

Line 303: tempo-rarily, replace with temporarily

Response 1.2

Thank you for pointing this out. The manuscript has been changed accordingly.

Reviewer 2

Comment 2.1:

Actually a very good paper although it is a retrospective analysis. The results depend also from the reasons those drugs are administrated; so the chronic diseases which lead to the prescription may have a more important role in the evolving PJI than the drugs themselves. But as you do talk in an appropriate way about that problem in your discussion.

Response 2.1

Thank you for your comment and positive feedback.

Additional corrections

We noticed that the crude hazard ratio and confidence interval for statins in the result section differed between the text and table 2. We adjusted the hazard ratio and confidence interval appropriately, see line 190.

Reviewer 2 Report

Actually a very good paper although it is a retrospective analysis. The reults depend also from the reasons those drugs are administrated; so the chronic diseases which lead to the prescription may have a more important role in the evolving PJI than the drugs themselves. But as you do talk in a appropiate way  about that problem in your discussion.

Author Response

Reviewer 1

PJI is one of the most serious complications following total joint arthroplasty. ICS were widely used in Asthma and COPD patients. Anticoagulants and cardiovascular drugs also extensively used in clinic. This manuscript by Bruin et al. addressed an increased risk of PJI associated with ICS, anticoagulants (VKA, PAI, DOAC), and cardiovascular drugs (amlodipine), which demonstrating a significant concern in clinical.

The analysis is based on large cases in the long period of time (8 years) which make the results solid.

Furthermore, this manuscript is well constructed. So, I suggested it can be published by the journal.

Response

Thank you for the thorough evaluation and helpful comments.

Comment 1.1:

When referring to a bacterium in a paper, the writer should italicize the names in the text (I am not sure it is requested or not by the journal).

Response 1.1

Thank you for your comments. We italicized the bacterium in our manuscript.

Comment 1.2:

Line 271: complica-tions, replace with complications

Line 276: pa-tients, replace with patients

Line 280: compli-cations, replace with complications

Line 281: interna-tional, replace with international

Line 282: pa-tients, replace with patients

Line 290: periop-erative, replace with perioperative

Line 291: compli-cations, replace with complications

Line 295: misclassifica-tion, replace with misclassification

Line 297: con-servative, replace with conservative

Line 303: tempo-rarily, replace with temporarily

Response 1.2

Thank you for pointing this out. The manuscript has been changed accordingly.

Reviewer 2

Comment 2.1:

Actually a very good paper although it is a retrospective analysis. The results depend also from the reasons those drugs are administrated; so the chronic diseases which lead to the prescription may have a more important role in the evolving PJI than the drugs themselves. But as you do talk in an appropriate way about that problem in your discussion.

Response 2.1

Thank you for your comment and positive feedback.

Additional corrections

We noticed that the crude hazard ratio and confidence interval for statins in the result section differed between the text and table 2. We adjusted the hazard ratio and confidence interval appropriately, see line 190.