Epidemiology and Drug Resistance of Fracture-Related Infection of the Long Bones of the Extremities: A Retrospective Study at the Largest Trauma Center in Southwest China

Abstract

ObjectiveTo describe the demographic characteristics, risk factors, and bacterial resistance of fracture-related infection (FRI) of the long bones of the extremities.Materials and MethodsThis single-center study retrospectively evaluated patients with FRI of the long bones of the extremities at West China Hospital between January 2012 and December 2017, and analyzed the demographic characteristics, risk factors, distribution of pathogenic bacteria, and bacterial drug resistance.ResultsAmong 9,900 patients, 535 patients (5.4%) were diagnosed with FRI. The most common site of FRI was tibiofibular (298, 55.7%), with 424 cases (79.2%) of open fractures, and 282 cases (52.7%) due to traffic injuries. The 41–50 years age group had the highest incidence of FRI with 157 (29.3%) cases. Overall, 546 strains of 52 types of bacteria were detected in FRI patients, with 105 strains of multidrug-resistant (MDR) bacteria. Methicillin-resistant Staphylococcus aureus (48, 8.8%) and extended-spectrum-β-lactamase Escherichia coli (32, 5.8%) accounted for the largest proportion. Multivariate logistic regression analysis showed that sex (odds ratio [OR] 1.813; 95% confidence interval [CI], 1.071∼3.070; P = 0.027) and fracture type (OR 3.128; 95% CI, 1.683∼5.815; P < 0.001) were independent risk factors for monomicrobial infection (MI). Female sex (OR 4.190; 95% CI, 1.212∼14.486; P = 0.024) was an independent risk factor for polymicrobial infection (PI).ConclusionThis study clarified the infection rates, changes in the bacterial spectrum, and drug resistance characteristics, and risk factors of FRI of the long bones of the extremities in the largest trauma center in southwest China.

Aetiology of long bone chronic osteomyelitis: an analysis of the current situation in one region in Egypt

“…In the present study, MRSA remains the most frequent single isolate at 36.4% (n = 12), in agreement with many previous studies, which reported an incidence ranging between 20 and 48% [4,12,13,15,16,23]. However, two studies from the same team ten years apart [12,15] reported very similar incidences of staphylococcus infections (31.3%-37.5%) in both cohorts, yet, there was a declining proportion of MRSA from 30.8 to 11.4% of all staph infections, respectively.…”

“…In the current study, the tibia (48.5%) was the most frequent site of chronic osteomyelitis. Many studies had similar findings [4,7,12,13,15,16]. Two other studies reported the femur as the most frequent infected bone [14,23]; in our report, the femur was the second affected bone (30.3%).…”

“…The aetiology of COM in our study was post-operative in half of the patients. In other studies, haematogenous osteomyelitis or OM following open fractures were the leading cause [13,15,16]. Post-operative COM was only 29.3%, 9.9%, and 2.8% of the whole cohorts, respectively [4,12,13].…”

“…Several studies analysed the bacteriological profile in long bone osteomyelitis [3,[5][6][7][8][12][13][14][15][16]. Reports from low resources settings and developing countries are sparse [4,9,10,17,18].…”

Comparative analysis of pathogen distribution in patients with fracture-related infection and periprosthetic joint infection: a retrospective study

“…A comparison of bacteria isolated from open fractures following debridement and subsequent infection concluded that 60.8% of postoperative infections were caused by MDROs [ 37 ]. Zhang et al [ 38 ] reported that 546 strains of pathogens were detected in FRI patients, with only 105 strains (19.2%) of MDROs. The pathogenesis of FRI was more complex, and patients with FRI were more severely ill, resulting in more bacterial species and higher MDR infection rates in the FRI cohort.…”