Time-dependent differences in management and microbiology of orthopaedic internal fixation-associated infections: an observational prospective study with 229 patients.
Anti-Bacterial Agents
/ therapeutic use
Debridement
Enterobacteriaceae
/ drug effects
Enterobacteriaceae Infections
/ drug therapy
Female
Fracture Fixation, Internal
/ adverse effects
Humans
Male
Middle Aged
Prospective Studies
Prosthesis-Related Infections
/ drug therapy
Staphylococcal Infections
/ drug therapy
Staphylococcus aureus
/ drug effects
Tertiary Healthcare
Time Factors
Antibiotic therapy
Biofilm
Fracture-related infection
Implant-associated infection
Orthopaedic fixation device
Osteomyelitis
Surgical management
Journal
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
ISSN: 1469-0691
Titre abrégé: Clin Microbiol Infect
Pays: England
ID NLM: 9516420
Informations de publication
Date de publication:
Jan 2019
Jan 2019
Historique:
received:
20
10
2017
revised:
07
03
2018
accepted:
28
03
2018
pubmed:
13
4
2018
medline:
26
4
2019
entrez:
13
4
2018
Statut:
ppublish
Résumé
Little information has been published on orthopaedic internal fixation-associated infections. We aimed to analyse time-dependent microbiology, treatment, and outcome. Over a 10-year period, all consecutive patients with internal fixation-associated infections at the University Hospital of Basel, were prospectively followed and clinical, microbiological and outcome data were acquired. Infections were classified as early (0-2 weeks after implantation), delayed (3-10 weeks), and late (>10 weeks). Two hundred and twenty-nine patients were included, with a median follow-up of 773 days (IQR 334-1400). Staphylococcus aureus was the most prevalent pathogen (in 96/229 patients, 41.9%). Enterobacteriaceae were frequent in early infections (13/49, 26.5%), whereas coagulase-negative staphylococci (36/92, 39.1%), anaerobes (15/92, 16.3%) and streptococci (10/92, 10.9%) increased in late revisions. Failure was observed in 27/229 (11.7%). Implants were retained in 42/49 (85.7%) in early, in 51/88 (57.9%) in delayed, and in 9/92 (9.8%) in late revisions (p < 0.01). Early revisions failed in 6/49 (12.2%), delayed in 9/88 (10.2%), and late in 11/92 (13.0%) (p 0.81). Debridement and retention failed in 6/42 (14.3%) for early, in 6/51 (11.8%) for delayed, and in 3/9 (33.3%) for late revisions (p 0.21). Biofilm-active antibiotic therapy tailored to resistance correlated with improved outcome for late revisions failure (6/72, 7.7% versus 6/12, 50.0%; p < 0.01) but not for early revisions failure (5/38, 13.2% versus 1/11, 9.1%; p 1.0). Treatment of internal fixation-associated infections showed a high success rate of 87-90% over all time periods. Implant retention was highly successful in early and delayed infections but only limited in late infections.
Identifiants
pubmed: 29649599
pii: S1198-743X(18)30318-5
doi: 10.1016/j.cmi.2018.03.040
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
76-81Informations de copyright
Copyright © 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.