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

Abstract

Background The purpose of this study is to investigate the microbial patterns of periprosthetic joint infection (PJI) and fracture-related infection (FRI), and guide for the formulation of more accurate empirical antimicrobial regimens based on the differences in pathogen distribution. Methods A comparative analysis of pathogen distribution was conducted between 153 patients (76 with PJI and 77 with FRI). Predicted analyses against isolated pathogens from two cohorts were conducted to evaluate the best expected efficacy of empirical antimicrobial regimens (imipenem + vancomycin, ciprofloxacin + vancomycin, and piperacillin/tazobactam + vancomycin). Results Our study found significant differences in pathogen distribution between the PJI and FRI cohorts. Staphylococci (61.3% vs. 31.9%, p = 0.001) and Gram-negative bacilli (GNB, 26.7% vs. 56.4%, p < 0.001) were responsible for the majority of infections both in the PJI and FRI cohorts, and their distribution in the two cohorts showed a significant difference (p < 0.001). Multi-drug resistant organisms (MDRO) were more frequently detected in the FRI cohort (29.3% vs. 44.7%, p = 0.041), while methicillin-resistant coagulase-negative Staphylococci (MRCoNS, 26.7% vs. 8.5%, p = 0.002) and Canidia albicans (8.0% vs. 1.1%, p = 0.045) were more frequently detected in the PJI cohort. Enterobacter spp. and Acinetobacter baumannii were detected only in the FRI cohort (11.7% and 8.5%, respectively). Conclusions Staphylococci and GNB were responsible for the majority of infections in both PJI and FRI. Empirical antimicrobial therapy should focus on the coverage of Staphylococci in PJI and GNB in FRI, and infections caused by MDROs should be more vigilant in FRI, while the high incidence of MRCoNS in PJI should be noted, which could guide for the formulation of more accurate empirical antimicrobial regimens. Targeted therapy for FRI caused by A. baumannii and PJI caused by C. albicans needs to be further investigated. Our study reports significant differences in pathogen distribution between the two infections and provides clinical evidence for studies on the mechanism of implant-associated infection.

The Microbiological Profile and Antibiotic Susceptibility of Fracture Related Infections in a Low Resource Setting Differ from High Resource Settings: A Cohort Study from Cameroon

“…In contrast, our overall incidence of Gram-negative bacteria (GNB) (65.8%) is two to three times higher than other studies from the HIC [ 3 , 18 , 19 , 20 ] ( Table 4 ). However, recent studies in China and South Africa found that GNB represented 47–70% of the causative pathogens of FRI, which is similar to our findings [ 12 , 13 , 15 , 21 ]. In these studies, the most commonly isolated pathogens were similar to our findings: S. aureus , followed by Enterobacter cloacae , Escherichia coli , Acinetobacter baumanii , and Pseudomonas aeruginosa [ 21 ].…”

“…There are recommendations from HIC that EAT for FRI should be broad-spectrum, including a lipopeptide or a glycopeptide and an agent covering Gram-negative bacilli [ 5 ]. As there is no evidence-based guideline from LMIC, EAT protocols in those settings are often extrapolated from the results of the studies conducted in HIC, where the conditions may be very different [ 12 ]. Due to different national, geographical, and socioeconomic conditions, the bacterial epidemiology might be different, leading to different EAT recommendations [ 12 ].…”

“…As there is no evidence-based guideline from LMIC, EAT protocols in those settings are often extrapolated from the results of the studies conducted in HIC, where the conditions may be very different [ 12 ]. Due to different national, geographical, and socioeconomic conditions, the bacterial epidemiology might be different, leading to different EAT recommendations [ 12 ]. Identifying the microbiological pathogens responsible for FRI in that specific environment is necessary to select appropriate initial antibiotic therapy and develop adequate prevention strategies.…”

Distribution of pathogens and risk factors for post-replantation wound infection in patients with traumatic major limb mutilation

“…The etiological distribution of postoperative wound infection varies according to different surgical reasons, sites and even seasons [ 9 , 11 , 12 , 37 ]. Reports on etiological characteristics after regrafting of severe traumatic mutilation of major limbs were limited.…”

Epidemiological updates of post-traumatic related limb osteomyelitis in china: a 10 years multicenter cohort study

“…Recent studies, conducted in Northeast and East China with limited numbers of multicenters, have revealed the distribution of pathogenic bacteria on FRI. However, neither of these studies could provide significant evidence to reveal the relative risk factors among the infected populations, nor the dynamic changes of major pathogens during the past period 11 , 17 . To address these gaps, we conducted a comprehensive 10-year retrospective multicenter study to examine dynamic changes in infection rates and identify risk factors for monomicrobial and polymicrobial infection.…”