Pathogenesis and management of fracture-related infection

Abstract

Background: Both fracture-related infections (FRIs) and periprosthetic joint infections (PJIs) include orthopaedic implant-associated infections. However, key aspects of management differ due to the bone and soft tissue damage in FRIs and the option of removing the implant after fracture healing. In contrast to PJIs, research and guidelines for diagnosis and treatment in FRIs are scarce. Objectives: This narrative review aims to update clinical microbiologists, infectious disease specialists and surgeons on the management of FRIs. Sources: A computerized search of PubMed was performed to identify relevant studies. Search terms included 'Fracture' and 'Infection'. The reference lists of all retrieved articles were checked for additional relevant references. In addition, when scientific evidence was lacking, recommendations are based on expert opinion. Content: Pathogenesis, prevention, diagnosis and treatment of FRIs are presented. Whenever available, specific data of patients with FRI are discussed. Implications: Management of patients with FRI should take into account FRI-specific features. Treatment pathways should implement a multidisciplinary approach to achieve a good outcome. Recently, international consensus guidelines were developed to improve the quality of care for patients suffering from this severe complication, which are highlighted in this review.

Intramedullary tissue cultures from the Reamer‐Irrigator‐Aspirator system for diagnosing fracture‐related infection

“…In our series, five patients (21%) had a polymicrobial infection, which is in line with what is described in the literature 26,27 . Interestingly, overall, the most commonly encountered microorganisms (38%) were coagulase‐negative staphylococci (eg, S. epidermidis) , whereas S. aureus was only found in 8% of the FRI patients.…”

“…11 These should be acquired in addition to In our series, five patients (21%) had a polymicrobial infection, which is in line with what is described in the literature. 26,27 Interestingly, overall, the most commonly encountered microorganisms (38%) were coagulase-negative staphylococci (eg, S. epidermidis), whereas S. aureus was only found in 8% of the FRI patients. These results are slightly controversial to what is described in the literature, where S. aureus is reported to be the most common causative pathogen in FRI. 15,28 A recent review by Depypere et al 26 stated that S. aureus is found in 30% to 42% and coagulase-negative staphylococci (including S. epidermidis) in 20% to 39% of the FRI patients.…”

“…26,27 Interestingly, overall, the most commonly encountered microorganisms (38%) were coagulase-negative staphylococci (eg, S. epidermidis), whereas S. aureus was only found in 8% of the FRI patients. These results are slightly controversial to what is described in the literature, where S. aureus is reported to be the most common causative pathogen in FRI. 15,28 A recent review by Depypere et al 26 stated that S. aureus is found in 30% to 42% and coagulase-negative staphylococci (including S. epidermidis) in 20% to 39% of the FRI patients. 26 Our data originates from a tertiary university center, where patients are admitted from across the country and some of them already underwent multiple treatments in other hospitals.…”

“…These results are slightly controversial to what is described in the literature, where S. aureus is reported to be the most common causative pathogen in FRI. 15,28 A recent review by Depypere et al 26 stated that S. aureus is found in 30% to 42% and coagulase-negative staphylococci (including S. epidermidis) in 20% to 39% of the FRI patients. 26 Our data originates from a tertiary university center, where patients are admitted from across the country and some of them already underwent multiple treatments in other hospitals. This could explain the fact that the percentage of coagulase-negative staphylococci is higher, as most of these patients have chronic/lateonset infections.…”

Diagnostic accuracy of 99mTc-antigranulocyte SPECT/CT in patients with osteomyelitis and orthopaedic device-related infections: A retrospective analysis

“…The revised MSIS criteria published in 2013 served as reference standard for the diagnosis of PJI (Parvizi et al, 2013;Parvizi and Gehrke, 2014). The reference standard for the diagnosis of OM and OAI was proof of the same pathogen in two intraoperatively obtained specimen and/or clear evidence of OM in histopathology (Depypere et al, 2019). Histology was positive if signs of acute inflammation with dominance of neutrophils in at least one tissue sample were present.…”