What Factors Affect Outcome in the Treatment of Fracture-Related Infection?
This international, multi-center study investigated the effect of individual components of surgery on the clinical outcomes of patients treated for fracture-related infection (FRI). All patients with surgically treated FRIs, confirmed by the FRI consensus definition, were included. Data were collect...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-07-01
|
| Series: | Antibiotics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2079-6382/11/7/946 |
| _version_ | 1797433961926885376 |
|---|---|
| author | Martin McNally Ruth Corrigan Jonathan Sliepen Maria Dudareva Rob Rentenaar Frank IJpma Bridget L. Atkins Marjan Wouthuyzen-Bakker Geertje Govaert |
| author_facet | Martin McNally Ruth Corrigan Jonathan Sliepen Maria Dudareva Rob Rentenaar Frank IJpma Bridget L. Atkins Marjan Wouthuyzen-Bakker Geertje Govaert |
| author_sort | Martin McNally |
| collection | DOAJ |
| description | This international, multi-center study investigated the effect of individual components of surgery on the clinical outcomes of patients treated for fracture-related infection (FRI). All patients with surgically treated FRIs, confirmed by the FRI consensus definition, were included. Data were collected on demographics, time from injury to FRI surgery, soft tissue reconstruction, stabilization and systemic and local anti-microbial therapy. Patients were followed up for a minimum of one year. In total, 433 patients were treated with a mean age of 49.7 years (17–84). The mean follow-up time was 26 months (range 12–72). The eradication of infection was successful in 86.4% of all cases and 86.0% of unhealed infected fractures were healed at the final review. In total, 3.3% required amputation. The outcome was not dependent on age, BMI, the presence of metalwork or time from injury (recurrence rate 16.5% in FRI treated at 1–10 weeks after injury; 13.1% at 11–52 weeks; 12.1% at >52 weeks: <i>p</i> = 0.52). The debridement and retention of a stable implant (DAIR) had a failure rate of 21.4%; implant exchange to a new internal fixation had a failure rate of 12.5%; and conversion to external fixation had a failure rate of 10.3% (adjusted hazard ratio (aHR) DAIR vs. Ext Fix 2.377; 95% C.I. 0.96–5.731). Tibial FRI treated with a free flap was successful in 92.1% of cases and in 80.4% of cases without a free flap (HR 0.38; 95% C.I. 0.14–1.0), while the use of NPWT was associated with higher recurrence rates (HR 3.473; 95% C.I. 1.852–6.512). The implantation of local antibiotics reduced the recurrence from 18.7% to 10.0% (HR 0.48; 95% C.I. 0.29–0.81). The successful treatment of FRI was multi-factorial. These data suggested that treatment decisions should not be based on time from injury alone, as other factors also affected the outcome. Further work to determine the best indications for DAIR, free flap reconstruction and local antibiotics is warranted. |
| first_indexed | 2024-03-09T10:24:26Z |
| format | Article |
| id | doaj.art-9752accd876042e0a1e17b427dbbb4ff |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-09T10:24:26Z |
| publishDate | 2022-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-9752accd876042e0a1e17b427dbbb4ff2023-12-01T21:49:09ZengMDPI AGAntibiotics2079-63822022-07-0111794610.3390/antibiotics11070946What Factors Affect Outcome in the Treatment of Fracture-Related Infection?Martin McNally0Ruth Corrigan1Jonathan Sliepen2Maria Dudareva3Rob Rentenaar4Frank IJpma5Bridget L. Atkins6Marjan Wouthuyzen-Bakker7Geertje Govaert8Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford OX3 9DU, UKBone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford OX3 9DU, UKDepartment of Trauma Surgery, University Medical Centre Groningen, University of Groningen, 9712 CP Groningen, The NetherlandsBone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford OX3 9DU, UKDepartment of Medical Microbiology, University Medical Centre Utrecht, 3584 CX Utrecht, The NetherlandsDepartment of Trauma Surgery, University Medical Centre Groningen, University of Groningen, 9712 CP Groningen, The NetherlandsBone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford OX3 9DU, UKDepartment of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, University of Groningen, 9712 CP Groningen, The NetherlandsDepartment of Trauma Surgery, University Medical Centre Utrecht, 3584 CX Utrecht, The NetherlandsThis international, multi-center study investigated the effect of individual components of surgery on the clinical outcomes of patients treated for fracture-related infection (FRI). All patients with surgically treated FRIs, confirmed by the FRI consensus definition, were included. Data were collected on demographics, time from injury to FRI surgery, soft tissue reconstruction, stabilization and systemic and local anti-microbial therapy. Patients were followed up for a minimum of one year. In total, 433 patients were treated with a mean age of 49.7 years (17–84). The mean follow-up time was 26 months (range 12–72). The eradication of infection was successful in 86.4% of all cases and 86.0% of unhealed infected fractures were healed at the final review. In total, 3.3% required amputation. The outcome was not dependent on age, BMI, the presence of metalwork or time from injury (recurrence rate 16.5% in FRI treated at 1–10 weeks after injury; 13.1% at 11–52 weeks; 12.1% at >52 weeks: <i>p</i> = 0.52). The debridement and retention of a stable implant (DAIR) had a failure rate of 21.4%; implant exchange to a new internal fixation had a failure rate of 12.5%; and conversion to external fixation had a failure rate of 10.3% (adjusted hazard ratio (aHR) DAIR vs. Ext Fix 2.377; 95% C.I. 0.96–5.731). Tibial FRI treated with a free flap was successful in 92.1% of cases and in 80.4% of cases without a free flap (HR 0.38; 95% C.I. 0.14–1.0), while the use of NPWT was associated with higher recurrence rates (HR 3.473; 95% C.I. 1.852–6.512). The implantation of local antibiotics reduced the recurrence from 18.7% to 10.0% (HR 0.48; 95% C.I. 0.29–0.81). The successful treatment of FRI was multi-factorial. These data suggested that treatment decisions should not be based on time from injury alone, as other factors also affected the outcome. Further work to determine the best indications for DAIR, free flap reconstruction and local antibiotics is warranted.https://www.mdpi.com/2079-6382/11/7/946fracture-related infectionnon-unioninfectionfractureoutcomeDAIR |
| spellingShingle | Martin McNally Ruth Corrigan Jonathan Sliepen Maria Dudareva Rob Rentenaar Frank IJpma Bridget L. Atkins Marjan Wouthuyzen-Bakker Geertje Govaert What Factors Affect Outcome in the Treatment of Fracture-Related Infection? Antibiotics fracture-related infection non-union infection fracture outcome DAIR |
| title | What Factors Affect Outcome in the Treatment of Fracture-Related Infection? |
| title_full | What Factors Affect Outcome in the Treatment of Fracture-Related Infection? |
| title_fullStr | What Factors Affect Outcome in the Treatment of Fracture-Related Infection? |
| title_full_unstemmed | What Factors Affect Outcome in the Treatment of Fracture-Related Infection? |
| title_short | What Factors Affect Outcome in the Treatment of Fracture-Related Infection? |
| title_sort | what factors affect outcome in the treatment of fracture related infection |
| topic | fracture-related infection non-union infection fracture outcome DAIR |
| url | https://www.mdpi.com/2079-6382/11/7/946 |
| work_keys_str_mv | AT martinmcnally whatfactorsaffectoutcomeinthetreatmentoffracturerelatedinfection AT ruthcorrigan whatfactorsaffectoutcomeinthetreatmentoffracturerelatedinfection AT jonathansliepen whatfactorsaffectoutcomeinthetreatmentoffracturerelatedinfection AT mariadudareva whatfactorsaffectoutcomeinthetreatmentoffracturerelatedinfection AT robrentenaar whatfactorsaffectoutcomeinthetreatmentoffracturerelatedinfection AT frankijpma whatfactorsaffectoutcomeinthetreatmentoffracturerelatedinfection AT bridgetlatkins whatfactorsaffectoutcomeinthetreatmentoffracturerelatedinfection AT marjanwouthuyzenbakker whatfactorsaffectoutcomeinthetreatmentoffracturerelatedinfection AT geertjegovaert whatfactorsaffectoutcomeinthetreatmentoffracturerelatedinfection |