The Microbiological Etiology of Fracture-Related Infection
PurposeFracture-related infection (FRI) is an important complication related to orthopaedic trauma. Although the scientific interest with respect to the diagnosis and treatment of FRI is increasing, data on the microbiological epidemiology remains limited. Therefore, the primary aim of this study wa...
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| Format: | Article |
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Cellular and Infection Microbiology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcimb.2022.934485/full |
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| author | Melissa Depypere Melissa Depypere Jonathan Sliepen Jolien Onsea Jolien Onsea Yves Debaveye Geertje A. M. Govaert Frank F. A. IJpma Werner Zimmerli Willem-Jan Metsemakers Willem-Jan Metsemakers |
| author_facet | Melissa Depypere Melissa Depypere Jonathan Sliepen Jolien Onsea Jolien Onsea Yves Debaveye Geertje A. M. Govaert Frank F. A. IJpma Werner Zimmerli Willem-Jan Metsemakers Willem-Jan Metsemakers |
| author_sort | Melissa Depypere |
| collection | DOAJ |
| description | PurposeFracture-related infection (FRI) is an important complication related to orthopaedic trauma. Although the scientific interest with respect to the diagnosis and treatment of FRI is increasing, data on the microbiological epidemiology remains limited. Therefore, the primary aim of this study was to evaluate the microbiological epidemiology related to FRI, including the association with clinical symptoms and antimicrobial susceptibility data. The secondary aim was to analyze whether there was a relationship between the time to onset of infection and the microbiological etiology of FRI.MethodsFRI patients treated at the University Hospitals of Leuven, Belgium, between January 1st 2015 and November 24th 2019 were evaluated retrospectively. The microbiological etiology and antimicrobial susceptibility data were analyzed. Patients were classified as having an early (<2 weeks after implantation), delayed (2-10 weeks) or late-onset (> 10 weeks) FRI.ResultsOne hundred ninety-one patients with 194 FRIs, most frequently involving the tibia (23.7%) and femur (18.6%), were included. Staphylococcus aureus was the most frequently isolated pathogen, regardless of time to onset (n=61; 31.4%), followed by S. epidermidis (n=50; 25.8%) and non-epidermidis coagulase-negative staphylococci (n=35; 18.0%). Polymicrobial infections (n=49; 25.3%), mainly involving Gram negative bacilli (GNB) (n=32; 65.3%), were less common than monomicrobial infections (n=138; 71.1%). Virulent pathogens in monomicrobial FRIs were more likely to cause pus or purulent discharge (n=45;54.9%; p=0.002) and fistulas (n=21;25.6%; p=0.030). Susceptibility to piperacillin/tazobactam for GNB was 75.9%. Vancomycin covered 100% of Gram positive cocci.ConclusionThis study revealed that in early FRIs, polymicrobial infections and infections including Enterobacterales and enterococcal species were more frequent. A time-based FRI classification is not meaningful to estimate the microbiological epidemiology and cannot be used to guide empiric antibiotic therapy. Large multicenter prospective studies are necessary to gain more insight into the added value of (broad) empirical antibiotic therapy. |
| first_indexed | 2024-12-11T03:30:47Z |
| format | Article |
| id | doaj.art-d1266bb14cbf4f278941aea72749caaa |
| institution | Directory Open Access Journal |
| issn | 2235-2988 |
| language | English |
| last_indexed | 2024-12-11T03:30:47Z |
| publishDate | 2022-07-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Cellular and Infection Microbiology |
| spelling | doaj.art-d1266bb14cbf4f278941aea72749caaa2022-12-22T01:22:23ZengFrontiers Media S.A.Frontiers in Cellular and Infection Microbiology2235-29882022-07-011210.3389/fcimb.2022.934485934485The Microbiological Etiology of Fracture-Related InfectionMelissa Depypere0Melissa Depypere1Jonathan Sliepen2Jolien Onsea3Jolien Onsea4Yves Debaveye5Geertje A. M. Govaert6Frank F. A. IJpma7Werner Zimmerli8Willem-Jan Metsemakers9Willem-Jan Metsemakers10Department of laboratory medicine, University Hospitals Leuven, Leuven, BelgiumDepartment of Microbiology, Immunology and Transplantation, Laboratory of Clinical Bacteriology and Mycology, KU Leuven, Leuven, BelgiumDepartment of Trauma Surgery, University Medical Center Groningen, Groningen, NetherlandsDepartment of Trauma Surgery, University Hospitals Leuven, Leuven, BelgiumDepartment of Development and Regeneration, KU Leuven - University of Leuven, Leuven, BelgiumDepartment of Intensive Care Medicine, University Hospitals Leuven, Leuven, BelgiumDepartment of Trauma Surgery, University of Utrecht, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Trauma Surgery, University Medical Center Groningen, Groningen, NetherlandsBasel University Medical Clinic, Kantonsspital Baselland, Liestal, SwitzerlandDepartment of Trauma Surgery, University Hospitals Leuven, Leuven, BelgiumDepartment of Development and Regeneration, KU Leuven - University of Leuven, Leuven, BelgiumPurposeFracture-related infection (FRI) is an important complication related to orthopaedic trauma. Although the scientific interest with respect to the diagnosis and treatment of FRI is increasing, data on the microbiological epidemiology remains limited. Therefore, the primary aim of this study was to evaluate the microbiological epidemiology related to FRI, including the association with clinical symptoms and antimicrobial susceptibility data. The secondary aim was to analyze whether there was a relationship between the time to onset of infection and the microbiological etiology of FRI.MethodsFRI patients treated at the University Hospitals of Leuven, Belgium, between January 1st 2015 and November 24th 2019 were evaluated retrospectively. The microbiological etiology and antimicrobial susceptibility data were analyzed. Patients were classified as having an early (<2 weeks after implantation), delayed (2-10 weeks) or late-onset (> 10 weeks) FRI.ResultsOne hundred ninety-one patients with 194 FRIs, most frequently involving the tibia (23.7%) and femur (18.6%), were included. Staphylococcus aureus was the most frequently isolated pathogen, regardless of time to onset (n=61; 31.4%), followed by S. epidermidis (n=50; 25.8%) and non-epidermidis coagulase-negative staphylococci (n=35; 18.0%). Polymicrobial infections (n=49; 25.3%), mainly involving Gram negative bacilli (GNB) (n=32; 65.3%), were less common than monomicrobial infections (n=138; 71.1%). Virulent pathogens in monomicrobial FRIs were more likely to cause pus or purulent discharge (n=45;54.9%; p=0.002) and fistulas (n=21;25.6%; p=0.030). Susceptibility to piperacillin/tazobactam for GNB was 75.9%. Vancomycin covered 100% of Gram positive cocci.ConclusionThis study revealed that in early FRIs, polymicrobial infections and infections including Enterobacterales and enterococcal species were more frequent. A time-based FRI classification is not meaningful to estimate the microbiological epidemiology and cannot be used to guide empiric antibiotic therapy. Large multicenter prospective studies are necessary to gain more insight into the added value of (broad) empirical antibiotic therapy.https://www.frontiersin.org/articles/10.3389/fcimb.2022.934485/fullfractureinfectionfracture-related infectionmicrobiologyantibiotic resistance |
| spellingShingle | Melissa Depypere Melissa Depypere Jonathan Sliepen Jolien Onsea Jolien Onsea Yves Debaveye Geertje A. M. Govaert Frank F. A. IJpma Werner Zimmerli Willem-Jan Metsemakers Willem-Jan Metsemakers The Microbiological Etiology of Fracture-Related Infection Frontiers in Cellular and Infection Microbiology fracture infection fracture-related infection microbiology antibiotic resistance |
| title | The Microbiological Etiology of Fracture-Related Infection |
| title_full | The Microbiological Etiology of Fracture-Related Infection |
| title_fullStr | The Microbiological Etiology of Fracture-Related Infection |
| title_full_unstemmed | The Microbiological Etiology of Fracture-Related Infection |
| title_short | The Microbiological Etiology of Fracture-Related Infection |
| title_sort | microbiological etiology of fracture related infection |
| topic | fracture infection fracture-related infection microbiology antibiotic resistance |
| url | https://www.frontiersin.org/articles/10.3389/fcimb.2022.934485/full |
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