High prevalence of bacteria in clinically aseptic non-unions of the tibia and the femur in tissue biopsies

Otchwemah, Robin; Moczko, Tobias; Marche, Benedikt; Mattner, Frauke; Probst, Christian; Tjardes, Thorsten

doi:10.1007/s00068-018-1010-z

Cited by 11 publications

(10 citation statements)

References 19 publications

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“…Six (29%) studies [ 8 , 17 – 19 , 21 , 25 ] included patients with a history of infection (range of patients with prior infection: 5% [ 19 ] to 36% [ 25 ]). Six (29%) studies [ 3 , 20 , 28 – 30 , 32 ] did not report on infection history. In the nine remaining studies patients with history of infection were not included [ 9 , 10 , 16 , 22 – 24 , 26 , 27 , 31 ].…”

Section: Resultsmentioning

confidence: 99%

“…Seventeen (81%) studies [ 3 , 8 – 10 , 16 , 18 – 22 , 24 – 27 , 29 , 30 , 32 ] included patients with initially open fractures (range of patients with open fracture: 20% [ 29 ] to 82% [ 24 ]). Three studies [ 17 , 23 , 28 ] did not report this and one study [ 31 ] only included patients with closed fractures.…”

Section: Resultsmentioning

confidence: 99%

“…We did not differentiate the identified micro-organisms between those found in definitive “surprise” infected nonunions and in contaminated cultures. Fifteen (71%) studies described the numbers of micro-organisms that were cultured [ 3 , 8 – 10 , 16 , 17 , 19 , 21 , 23 , 24 , 26 , 27 , 29 , 30 , 32 ]. The most common genus cultured was Staphylococcus (72%), followed by Cutibacterium (15%) (Table 3 and Fig.…”

Section: Resultsmentioning

confidence: 99%

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Surprise positive culture rate in the treatment of presumed aseptic long-bone nonunion: a systematic review with meta-analysis of 2397 patients

Wagner,

van Trikt,

Visser

et al. 2023

Arch Orthop Trauma Surg

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Introduction In pre-operatively presumed aseptic nonunions, the definitive diagnosis of infection relies on intraoperative cultures. Our primary objective was to determine (1) the rate of surprise positive intraoperative cultures in presumed aseptic long-bone nonunion (surprise positive culture nonunion), and (2) the rate of surprise positive cultures that represent infection vs. contamination. Secondary objectives were to determine the healing and secondary surgery rates and to identify cultured micro-organisms. Materials and Methods We performed a systematic literature search of PubMed, Embase and Cochrane Libraries from 1980 until December 2021. We included studies reporting on ≥ 10 adult patients with a presumed aseptic long-bone nonunion, treated with a single-stage surgical protocol, of which intraoperative cultures were reported. We performed a meta-analysis for: (1) the rates of surprise positive culture nonunion, surprise infected nonunion, and contaminated culture nonunion, and (2) healing and (3) secondary surgery rates for each culture result. Risk of bias was assessed using the QUADAS-2 tool. Results 21 studies with 2,397 patients with a presumed aseptic nonunion were included. The rate of surprise positive culture nonunion was 16% (95%CI: 10–22%), of surprise infected nonunion 10% (95%CI: 5–16%), and of contaminated culture nonunion 3% (95%CI: 1–5%). The secondary surgery rate for surprise positive culture nonunion was 22% (95%CI: 9–38%), for surprise infected nonunion 14% (95%CI 6–22%), for contaminated culture nonunion 4% (95%CI: 0–19%), and for negative culture nonunion 6% (95CI: 1–13%). The final healing rate was 98% to 100% for all culture results. Coagulase-negative staphylococci accounted for 59% of cultured micro-organisms. Conclusion These results suggest that surprise positive cultures play a role in the clinical course of a nonunion and that culturing is important in determining the etiology of nonunion, even if the pre-operative suspicion for infection is low. High healing rates can be achieved in presumed aseptic nonunions, regardless of the definitive intraoperative culture result.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Surprise positive culture rate in the treatment of presumed aseptic long-bone nonunion: a systematic review with meta-analysis of 2397 patients

Wagner,

van Trikt,

Visser

et al. 2023

Arch Orthop Trauma Surg

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“…Additionally, polymicrobial infection is common and often includes Gram-negative organisms. 23 , 34 Clinical characteristics (open fracture, presence of metalwork, draining sinus, compromised host) do not discriminate sufficiently to anticipate who may be affected with polymicrobial or non-staphylococcal FRI. 23 The microbiological diagnosis of FRI must involve methods which determine antimicrobial susceptibility in individual microbial species, as antimicrobial sensitivity cannot be reliably predicted. Up to one third of classifiable organisms causing FRI may be multi-drug-resistant (MDR), even in countries with a low incidence of MDR infection.…”

Section: Microbiological Diagnosis Of Frimentioning

confidence: 99%

Definition and diagnosis of fracture-related infection

et al. 2020

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Fracture-related infection (FRI) is common and often diagnosed late. Accurate diagnosis is the beginning of effective treatment. Diagnosis can be difficult, particularly when there are no outward signs of infection. The new FRI definition, together with clear protocols for nuclear imaging, microbiological culture and histological analysis, should allow much better study design and a clearer understanding of infected fractures. In recent years, there has been a new focus on defining FRI and avoiding non-specific, poorly targeted treatment. Previous studies on FRI have often failed to define infection precisely and so are of limited value. This review highlights the essential principles of making the diagnosis and how clinical signs, serum tests, imaging, microbiology, molecular biology and histology all contribute to the diagnostic pathway. Cite this article: EFORT Open Rev 2020;5:614-619. DOI: 10.1302/2058-5241.5.190072

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“…12,13 Additionally, the problem of clinically occult infections is well known in other areas of orthopaedics: septic loosening in prosthetic joint infections and nonunion as a result of low-grade infection in fracture-related infections. 14,15 Although little evidence regarding the potential development of antibiotic resistance exists, an essential factor in minimizing the risk could be the sufficiently long application and adequate concentration of the vancomycin solution to ensure complete eradication of potential contamination. Schüttler et al 8 showed that concentrations below 5 mg/mL and applications shorter than 20 minutes result in persistent contamination.…”

Section: See Related Article On Page 953mentioning

confidence: 99%

Editorial Commentary: Vancomycin Soaking of the Graft in Anterior Cruciate Ligament Reconstruction: A Concept on the Way to Becoming the New Gold Standard

Pfeiffer

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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High prevalence of bacteria in clinically aseptic non-unions of the tibia and the femur in tissue biopsies

Cited by 11 publications

References 19 publications

Surprise positive culture rate in the treatment of presumed aseptic long-bone nonunion: a systematic review with meta-analysis of 2397 patients

Surprise positive culture rate in the treatment of presumed aseptic long-bone nonunion: a systematic review with meta-analysis of 2397 patients

Definition and diagnosis of fracture-related infection

Editorial Commentary: Vancomycin Soaking of the Graft in Anterior Cruciate Ligament Reconstruction: A Concept on the Way to Becoming the New Gold Standard

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