The effect of early broad-spectrum versus delayed narrow-spectrum antibiotic therapy on the primary cure rate of acute infection after osteosynthesis

Abstract

Purpose Infection near metal implants is a problem that presents challenging treatment dilemmas for physicians. The aim of this study was to analyse the efficacy of two treatment protocols for acute fracture-related infections. Methods Seventy-one patients in two level-1 trauma centres in the Netherlands were retrospectively included in this study. These trauma centres had different standardised protocols for acute infection after osteosynthesis: 39 patients were selected from protocol A and 32 from protocol B. Both protocols involve immediate surgical debridement and soft tissue coverage, but differ in antibiotic approach: (A) immediate empirical combination antibiotic therapy with rifampicin, or (B) postponed (1-5 days) targeted antibiotic therapy. The primary outcome of these protocols was success, defined as a fracture healing in the absence of infection. The secondary outcome was antibiotic resistance patterns. Logistic regression was conducted on patients and treatment-related factors in association with primary success. Results Primary success was achieved in 72% of protocol A patients, in 47% of those in protocol B (P = 0.033), and with prolongation of treatment success was achieved in 90% and 78% of patients, respectively. Protocol A exhibited a better primary success rate (adjusted OR 3.45, CI 1.13-10.52) when adjusted for age and soft tissue injury. There was no significant difference in antibiotic resistance between the two protocols. Conclusion Both protocols yielded high overall success rates. Immediate empirical antibiotics can be used safely without additional bacterial resistance and may contribute to increased success rates.

The Microbiological Etiology of Fracture-Related Infection

“…The current guidelines regarding empirical antibiotic therapy are not based on scientific data ( Depypere et al., 2019a ). Studies evaluating the need for empirical therapy in FRI are scarce ( Hellebrekers et al., 2020 ). When patients have a severe life-threatening infection (e.g.…”

Is There a Difference in Microbiological Epidemiology and Effective Empiric Antimicrobial Therapy Comparing Fracture-Related Infection and Periprosthetic Joint Infection? A Retrospective Comparative Study

“…There are limited data on the usefulness and adequate administration of empiric antibiotic therapy for bone and joint infections. For FRI, the inferiority of late-onset targeted antibiotic therapy has been demonstrated compared to early empiric antibiotic therapy using vancomycin combined with rifampicin [ 20 ]. However, the study included only acute FRIs in which implant retention was performed and both different antibiotic therapy protocols were compared retrospectively.…”

Outcome of Debridement, Antibiotics, and Implant Retention for Staphylococcal Hip and Knee Prosthetic Joint Infections, Focused on Rifampicin Use: A Systematic Review and Meta-Analysis

“…In these studies, rifampicin resistance had not developed in patients with positive cultures after failure. Rifampicin resistance in patients with failure after DAIR has been reported, but this was in patients who were not treated with adequate debridement or with combination therapy [ 31 , 32 ]. Whether the duration of rifampicin combination therapy affects outcome is unknown.…”