Definition and diagnosis of fracture-related infection

Abstract

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

Interleukin-6 versus Common Inflammatory Biomarkers for Diagnosing Fracture-Related Infection: Utility and Potential Influencing Factors

“…Among these issues, early and accurate diagnosis is of great importance, which is the premise of therapy. According to the recently achieved international consensus on FRI [ 17 ], clinical signs and findings before and during surgery, pathogen culture, and histology test can be regarded as confirmatory criteria of FRI. However, in some patients with untypical manifestations, FRI diagnosis can only be made during or even after surgery, which increases the misdiagnosis risk.…”

<i>Candida</i> fracture-related infection: a systematic review

“…The definition of fracture-related infection (FRI) was compliant with criteria recently reported by McNally et al (2020); the Candida etiology of FRI was based on the isolate of the microorganism in adequate and representative bone specimens related to the fracture (McNally et al, 2020). The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement when conducting and reporting this systematic review.…”

Optimal microbiological sampling for the diagnosis of osteoarticular infection

“…Diagnosis may be evident if a sinus tract, wound breakdown to bone or implant or pus are present. 33 Nonetheless, even in this scenario, accurate identification of the microorganism(s) responsible for infection is critical to ensure correct antibiotic therapy.…”

“…Samples should be collected in a structured process, with separate instruments for each sample, avoiding touching the patient’s skin with the sample or instrument. 33 , 42 Tissue samples should be obtained from infection-suspected deep tissues and not superficial tissue or fluid. Bone samples, especially sequesters or loose infected bone fragments, should always be collected in chronic osteomyelitis.…”