Effect of a standardized treatment regime for infection after osteosynthesis

Abstract

BackgroundInfection after osteosynthesis is an important complication with significant morbidity and even mortality. These infections are often caused by biofilm-producing bacteria. Treatment algorithms dictate an aggressive approach with surgical debridement and antibiotic treatment. The aim of this study is to analyze the effect of such an aggressive standardized treatment regime with implant retention for acute, existing <3 weeks, infection after osteosynthesis.MethodsWe conducted a retrospective 2-year cohort in a single, level 1 trauma center on infection occurring within 12 months following any osteosynthesis surgery. The standardized treatment regime consisted of implant retention, thorough surgical debridement, and immediate antibiotic combination therapy with rifampicin. The primary outcome was success. Success was defined as consolidation of the fracture and resolved symptoms of infection. Culture and susceptibility testing were performed to identify bacteria and resistance patterns. Univariate analysis was conducted on patient-related factors in association with primary success and antibiotic resistance.ResultsForty-nine patients were included for analysis. The primary success rate was 63% and overall success rate 88%. Factors negatively associated with primary success were the following: Gustilo classification (P = 0.023), higher number of debridements needed (P = 0.015), inability of primary closure (P = 0.017), and subsequent application of vacuum therapy (P = 0.030). Adherence to the treatment regime was positively related to primary success (P = 0.034).ConclusionsThe described treatment protocol results in high success rates, comparable with success rates achieved in staged exchange in prosthetic joint infection treatment.

Long-term follow-up after rib fixation for flail chest and multiple rib fractures

“…Pneumonia was defined as having clinical signs (fever, coughing, desaturation) requiring antibiotic treatment, with or without positive cultures. Implant-related infection was defined as clinical symptoms (e.g., redness, drainage from surgical wound, fever, pain, elevated CRP, or leukocytes) requiring incision and drainage and intravenous antibiotics following a previously published protocol [10]. ARDS was defined by severe hypoxemia with a PaO2/FIO2 smaller than 100 mm Hg.…”

Neutrophil heterogeneity and its role in infectious complications after severe trauma

“…The reason that more patients survive the initial trauma nowadays is mainly due to advances in (surgical) hemorrhage control and resuscitation [4]. However, after this first critical phase, patients can deteriorate again due to immune-related complications, such as an overwhelming immune response, severe infections, or recurrent infections later on [5, 6].…”

Intracellular Penetration and Effects of Antibiotics on Staphylococcus aureus Inside Human Neutrophils: A Comprehensive Review

“…Staphylococcus aureus ( S. aureus ) is a common causative pathogen in SSI or FRI [15,16,17]. S. aureus is notoriously known for its biofilm formation, especially in infections involving medical implants [18]. S. aureus has several other defense mechanisms, one of which is the ability to survive inside the phagosome of host cells [19].…”