DOES THE USE OF LOCAL ANTIBIOTICS AFFECT CLINICAL OUTCOME OF PATIENTS WITH FRACTURE-RELATED INFECTION?

Sliepen J, Corrigan R, Dudareva M, et al. DOES THE USE OF LOCAL ANTIBIOTICS AFFECT CLINICAL OUTCOME OF PATIENTS WITH FRACTURE-RELATED INFECTION?. Orthop Procs. 2022;104-B(SUPP_10):84-84. doi:10.1302/1358-992X.2022.10.084

Sliepen, J., et al. “DOES THE USE OF LOCAL ANTIBIOTICS AFFECT CLINICAL OUTCOME OF PATIENTS WITH FRACTURE-RELATED INFECTION?.” Orthopaedic Proceedings, vol. 104-B, no. SUPP_10, 2022, pp. 84-84., https://doi.org/10.1302/1358-992X.2022.10.084

Sliepen, J., Corrigan, R., Dudareva, M., Wouthuyzen-Bakker, M., Rentenaar, R., Atkins, B., Hietbrink, F., Govaert, G., McNally, M., & Ijpma, F. (2022). DOES THE USE OF LOCAL ANTIBIOTICS AFFECT CLINICAL OUTCOME OF PATIENTS WITH FRACTURE-RELATED INFECTION?. Orthopaedic Proceedings, 104-B(SUPP_10), 84-84. https://doi.org/10.1302/1358-992X.2022.10.084

Sliepen, J., Corrigan, R., Dudareva, M., Wouthuyzen-Bakker, M., Rentenaar, R., Atkins, B. et al. (2022) “DOES THE USE OF LOCAL ANTIBIOTICS AFFECT CLINICAL OUTCOME OF PATIENTS WITH FRACTURE-RELATED INFECTION?.” Orthopaedic Proceedings, 104-B(SUPP_10), pp. 84-84. Available at: https://doi.org/10.1302/1358-992X.2022.10.084

Sliepen, J., R. Corrigan, M. Dudareva, M. Wouthuyzen-Bakker, R. Rentenaar, B. Atkins, F. Hietbrink, G. Govaert, M. McNally, and F. Ijpma. “DOES THE USE OF LOCAL ANTIBIOTICS AFFECT CLINICAL OUTCOME OF PATIENTS WITH FRACTURE-RELATED INFECTION?.” Orthopaedic Proceedings 104-B, no. SUPP_10 (2022): 84-84. https://doi.org/10.1302/1358-992X.2022.10.084

Sliepen J, Corrigan R, Dudareva M, Wouthuyzen-Bakker M, Rentenaar R, Atkins B, et al. DOES THE USE OF LOCAL ANTIBIOTICS AFFECT CLINICAL OUTCOME OF PATIENTS WITH FRACTURE-RELATED INFECTION?. Orthop Procs. 2022 Oct 1;104-B(SUPP_10):84-84. https://doi.org/10.1302/1358-992X.2022.10.084

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Abstract

Background

Fracture-related infection (FRI) is treated by adequate debridement, lavage, fracture stabilization (if indicated), adequate soft tissue coverage and systemic antimicrobial therapy. Additional administration of local antibiotics (LA), placed directly in the surgical field, is thought to be beneficial for successful eradication of infection.

Aims

1) To evaluate the effect of local antibiotics on outcome in patients with FRI. 2) To evaluate whether bacterial resistance to the implanted local antibiotics influences its efficacy.

Methods

A multinational cross-sectional study was performed in patients with FRI, diagnosed according to the FRI consensus definition, between January 2015 and December 2019. Patients who underwent surgical treatment for FRI at all time points after injury were considered for inclusion. Patients were followed-up for at least 12 months. The primary outcome was the recurrence rate of FRI at follow-up. Inverse Probability for Treatment Weighting (IPTW) modeling and multivariable regression analyses were used to assess the relationship between the application of LA and recurrence rate of FRI at 12 months, 24 months and final follow-up.

Results

Overall, 433 FRIs in 429 patients were included. A total of 251 (58.0%) cases were treated with LA. Gentamicin was the most frequently used LA (247/251). Recurrence of infection after surgery occurred in 25/251 (10%) patients who received LA and in 34/182 (18.7%) patients who did not. The use of LA reduced the recurrence rate of FRI at 12 months (HR: 0.69; 95% CI [0.24–1.96]) and 24 months (HR: 0.55; 95% CI [0.22–1.35]). Resistance of cultured microorganisms to the LA was not associated with a higher risk of recurrence of FRI (HR: 0.75, 95% CI [0.32–1.74]).

Conclusion

The application of LA in treatment of FRI is likely to reduce the risk of recurrence of FRI as the risk reduction was consistent and clinically relevant but it did not reach statistical significance. High local antibiotic concentrations eradicate most pathogens regardless of susceptibility test results

E-mail: j.sliepen@umcg.nl