Conservative Medical Therapy of Infections Following Osteosynthesis: a Retrospective Analysis of a Six-Year Experience

Abstract

The conventional therapeutic approach to bone infection associated with osteosynthesis is based on the idea that microbial eradication is most readily achieved by removal of the foreign material together with adequate antimicrobial therapy. This strategy usually requires implantation of external fixation devices with additional discomfort to the patient. We report our experience with conservative medical and antimicrobial therapy without removal of the osteosynthesis until adequate bone callus deposition is documented by bone radiography scan. Twenty patients with infections associated with intramedullary nailing (9 patients), screws and plate (9 patients) or screws (2 patients) were treated between 1995 to 2000. Osteosynthesis implantation sites were tibia (7 patients), femur (6 patients), femur and tibia (1 patient), humerus (1 patient), others (5 patients). Diagnosis of infection was based on clinical-microbiological evidence and confirmed by 99Tc-labeled leukocyte scan studies. Offending pathogens were Staphylococcus aureus 17 cases, Staphylococcus aureus + Escherichia coli, Staphylococcus epidermidis, unknown, 1 case each. Most infections were initially treated with intravenous or intramuscular teicoplanin +/- ciprofloxacin or rifampin followed by oral antimicrobial therapy usually with ciprofloxacin or minocycline plus rifampin. Mean duration of antimicrobial therapy was 27.7 weeks (range 12-64 weeks). All patients (100%) were cured, and none complained of side-effects requiring antibiotic therapy discontinuation. We conclude that conservative medical therapy is feasible for osteosynthesis-associated bone infection.

Erfolgreiche Behandlung einer Osteosynthese-Infektion durch Enterococcus faecium nach multiplen offenen Beinfrakturen

“…In this patient, multimodal approach with stepwise reconstruction of the severely traumatized tissue and directed antibiotic therapy against E. faecium allowed recovery from this injury with a good functional result [3,5]. The basic principles of limb salvage using external fixation and control of the initial severe soft tissue injury using a VAC system and secondary stabilization and an attempt to treat the fractures with osteosynthesis were followed [7,8].…”

“…In case of trauma with requirement of reconstruction using metallic implants also other pathogens may be involved depending on the initial contamination [2,3]. Control of contamination=infection prior to implantation is desirable; however, it cannot always be achieved and therefore, during surgery of open fractures, perioperative prophylaxis using broad-spectrum antibiotics is used.…”

Italian Guidelines for the Diagnosis and Infectious Disease Management of Osteomyelitis and Prosthetic Joint Infections in Adults

“…This strategy usually requires the implantation of external fixation devices with additional discomfort to the patient. Pavoni et al [201] reported their experience with 20 patients with infections associated with intramedullary nailing (9 patients) screws and plates (9 patients) or screw (2 patients) treated between 1995 and 2000. The offending pathogens were S. aureus (17 cases), S. aureus plus Escherichia coli and S. epidermidis (1 case each).…”

Influência da ciprofloxacina na consolidação óssea de fraturas de fêmur em ratos

“…One example is ciprofloxacin, which is being indicated for several cases. [6][7][8][9][10][11][12][13] This is a bactericide antibiotics belonging to 2nd generation quinolones class, of which mechanism of action is to inhibit bacterial DNA synthesis by its cleavage. Its action is more effective when its serum concentration is thirty times higher than the minimum inhibitory concentration.…”