Multidisciplinary Treatment of Fracture-Related Infection Has a Positive Impact on Clinical Outcome-A Retrospective Case Control Study at a Tertiary Referral Center.

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Abstract

Fracture-related infection (FRI) is a major complication in orthopedic and trauma surgery. The management and choice of treatment can be difficult depending on multiple factors. Therefore, we implemented a weekly multidisciplinary team discussion to determine diagnostic and treatment strategies in FRI patients and aimed to analyze its effect on clinical outcomes.

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Most cited references 41

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A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation

Mary Charlson, Peter Pompei, Kathy Ales … (1987)

The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.

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Fracture-related infection: A consensus on definition from an international expert group.

W Metsemakers, M. Scarborough, S Kates … (2018)

Fracture-related infection (FRI) is a common and serious complication in trauma surgery. Accurately estimating the impact of this complication has been hampered by the lack of a clear definition. The absence of a working definition of FRI renders existing studies difficult to evaluate or compare. In order to address this issue, an expert group comprised of a number of scientific and medical organizations has been convened, with the support of the AO Foundation, in order to develop a consensus definition. The process that led to this proposed definition started with a systematic literature review, which revealed that the majority of randomized controlled trials in fracture care do not use a standardized definition of FRI. In response to this conclusion, an international survey on the need for and key components of a definition of FRI was distributed amongst all registered AOTrauma users. Approximately 90% of the more than 2000 surgeons who responded suggested that a definition of FRI is required. As a final step, a consensus meeting was held with an expert panel. The outcome of this process led to a consensus definition of FRI. Two levels of certainty around diagnostic features were defined. Criteria could be confirmatory (infection definitely present) or suggestive. Four confirmatory criteria were defined: Fistula, sinus or wound breakdown; Purulent drainage from the wound or presence of pus during surgery; Phenotypically indistinguishable pathogens identified by culture from at least two separate deep tissue/implant specimens; Presence of microorganisms in deep tissue taken during an operative intervention, as confirmed by histopathological examination. Furthermore, a list of suggestive criteria was defined. These require further investigations in order to look for confirmatory criteria. In the current paper, an overview is provided of the proposed definition and a rationale for each component and decision. The intention of establishing this definition of FRI was to offer clinicians the opportunity to standardize clinical reports and improve the quality of published literature. It is important to note that the proposed definition was not designed to guide treatment of FRI and should be validated by prospective data collection in the future.

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Diagnosis and treatment of infections associated with fracture-fixation devices.

Andrej Trampuz, Werner Zimmerli (2006)

The pathogenesis of infections associated with fracture-fixation devices is related to microorganisms growing in biofilms, which render these infections difficult to treat. These infections are classified as early ( 10 weeks) according to the implant surgery. Most infections are caused by staphylococci and are acquired during trauma (in penetrating injuries) or subsequent fracture-fixation procedures. A combination of clinical, laboratory, histopathology, microbiology, and imaging studies are usually needed to accurately diagnose infection. Magnetic resonance imaging (MRI) and computed tomography (CT) scans are often used to diagnose infection and plan surgical treatment. Positron emission tomography (PET) and PET-CT are promising new tools for diagnosing implant-associated osteomyelitis. The treatment goal is achieving bone consolidation and avoiding development of chronic osteomyelitis. Successful treatment requires adequate surgical procedures combined with 6-12 weeks of antimicrobial therapy acting on adhering stationary-phase microorganisms. In chronic osteomyelitis, orthopedic and plastic- reconstructive surgery is combined in the same procedure or within a short time span. In this article, pathogenesis, classification, diagnosis, and treatment of infections associated with intramedullary nails, external-fixation pins, plates, and screws are reviewed.

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Author and article information

Journal

Journal ID (iso-abbrev): Antibiotics (Basel)

Title: Antibiotics (Basel, Switzerland)

Publisher: MDPI AG

ISSN: 2079-6382

ISSN (Print): 2079-6382

Publication date (Electronic): Jan 21 2023

Volume: 12

Issue: 2

Affiliations

[1 ] Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany.

[2 ] Department for Psychosomatic Medicine, University Hospital Regensburg, 93053 Regensburg, Germany.

[3 ] Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany.

[4 ] Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, 93053 Regensburg, Germany.

[5 ] Center of Plastic and Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany.

[6 ] Department of Internal Medicine I, University Hospital Regensburg, 93053 Regensburg, Germany.

[7 ] Institute of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany.

[8 ] Department of Vascular Surgery, University Hospital Regensburg, 93053 Regensburg, Germany.

[9 ] Institute of Pathology, University Regensburg, 93053 Regensburg, Germany.

[10 ] Institute of Pathology, University Medical Center, 68167 Mannheim, Germany.

Article

Publisher Item ID: antibiotics12020230

DOI: 10.3390/antibiotics12020230

PMC ID: 9952612

PubMed ID: 36830141

SO-VID: 4dae6e92-4eb8-445e-8ec2-a53fed1602fe

History

Keywords: management concept,fracture-related infection,multidisciplinary treatment

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Keywords: management concept, fracture-related infection, multidisciplinary treatment

Multidisciplinary Treatment of Fracture-Related Infection Has a Positive Impact on Clinical Outcome-A Retrospective Case Control Study at a Tertiary Referral Center.

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Abstract

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Decoding Infection and Transmission

Most cited references 41

A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation

Fracture-related infection: A consensus on definition from an international expert group.

Diagnosis and treatment of infections associated with fracture-fixation devices.

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