Polymicrobial infections and microbial patterns in infected nonunions – a descriptive analysis of 42 cases

Rupp, Markus; Kern, Stefanie; Weber, Tobias; Menges, Tamina D.; Schnettler, Reinhard; Heiß, Christian; Alt, Volker

doi:10.1186/s12879-020-05386-9

Cited by 16 publications

(10 citation statements)

References 26 publications

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“…Staphylococcus aureus followed by Staphylococcus epidermidis were the most common evidenced pathogens causing FRI and PJI in the present study. This is in line with several studies investigating infection-causing agents [ 11 , 17 , 19 ]. Although no statistically significant difference could be found comparing pathogens causing PJI with pathogens evidenced in FRI, a higher rate of Enterococcus species and gram-negative bacteria in FRI might be due to a higher rate of previous antibiotic treatment against mainly gram-positive germs.…”

Section: Discussionsupporting

confidence: 90%

“…In the literature, higher rates of polymicrobial have been reported for PJI (16-46.6%) [9,10]. In infected nonunions, which represent FRI with cessation of bone healing for more than six months after fracture, a similar rate of polymicrobial infection has been reported (14.3%) [11]. Moreover, higher rates of polymicrobial infections in FRI have been described comparing different sampling protocols (25% and 36%, respectively) [12].…”

Section: Polymicrobial Infections Culture-negative Infections and Evidenced Pathogens In Pji And Frimentioning

confidence: 90%

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

et al. 2021

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This study aims to investigate (1) microbial patterns in fracture-related infections (FRIs) in comparison to microbiological patterns of periprosthetic joint infections (PJIs), (2) the identification of effective empiric antibiotic therapy for FRIs and PJIs and (3) analysis of difficult-to-treat (DTT) pathogens. Patients treated for FRIs or PJIs from 2017 to 2020 were evaluated for pathogens detected during treatment. Antibiotic susceptibility profiles were examined with respect to broadly used antibiotics and antibiotic combinations. Resistance rates to rifampicin or fluoroquinolone were determined. A total of 81 patients with PJI and 86 with FRI were included in the study. For FRIs Staphylococcus aureus was the most common infection-causing pathogen (37.4% vs. 27.9% for PJI). Overall, there was no statistical difference in pathogen distribution (p = 0.254). For FRIs, combinations of gentamicin + vancomycin (93.2%), co-amoxiclav + glycopeptide and meropenem + vancomycin (91.9% each) would have been effective for empiric therapy, similar to PJIs. Difficult to treat pathogens were more frequently detectable in PJIs (11.6% vs. 2.3%). Empiric therapy combinations such as gentamicin + vancomycin, co-amoxiclav + glycopeptide or meropenem + vancomycin, are effective antibiotic strategies for both FRI and PJI patients. More DTT pathogens were detectable in PJIs compared to FRIs.

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Section: Discussionsupporting

confidence: 90%

Section: Polymicrobial Infections Culture-negative Infections and Evidenced Pathogens In Pji And Frimentioning

confidence: 90%

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

et al. 2021

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“…Based on our results the application of gentamicin + vancomycin achieves high coverage of up to 94%, while resistance rates (1.7%) were low. In recurrent infections, higher rates of Gram-negative germs as well as polymicrobial infections should be expected [35]. Local carbapenems, which have been previously shown that they can be safely added to PMMA bone cement, could be a valuable option in these cases [36].…”

Section: Local Antibiotic Therapymentioning

confidence: 99%

What Is the Most Effective Empirical Antibiotic Treatment for Early, Delayed, and Late Fracture-Related Infections?

et al. 2022

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Antibiotic treatment strategies for fracture-related infections (FRI) are often extrapolated from periprosthetic joint infections (PJI), although, in contrast to PJI, detailed analysis of pathogens and their antibiotic resistance is missing. Therefore, this study aimed to investigate antibiotic susceptibility profiles to identify effective empiric antibiotic treatment for early-, delayed-, and late-onset FRI. Patients treated for FRI from 2013 to 2020 were grouped into early (<2 weeks), delayed (3–10 weeks), and late (>10 weeks) onset of infection. Antibiotic susceptibility profiles were examined with respect to broadly used antibiotics and antibiotic combinations. In total, 117 patients (early n = 19, delayed n = 60, late n = 38) were enrolled. In early-onset FRI, 100.0% efficacy would be achieved by meropenem + vancomycin, gentamicin + vancomycin, co-amoxiclav + glycopeptide, ciprofloxacin + glycopeptide and piperacillin/tazobactam + glycopeptide. For patients with delayed FRI, the highest susceptibility was revealed for meropenem + vancomycin, gentamicin + vancomycin and ciprofloxacin + glycopeptide (96.7%). Meropenem + vancomycin was the most effective empiric antimicrobial in patients with late-onset of infection with 92.1% coverage. No subgroup differences in antibiotic sensitivity profiles were observed except for the combination ciprofloxacin + glycopeptide, which was significantly superior in early FRI (F = 3.304, p = 0.04). Across all subgroups meropenem + vancomycin was the most effective empiric treatment in 95.7% of patients with confirmed susceptibility. Meropenem + vancomycin, gentamicin + vancomycin, co-amoxiclav + glycopeptide are the best therapeutic options for FRI, regardless of the onset of infection. To avoid multidrug resistance, established antibiotic combinations such as co-amoxiclav with a glycopeptide seem to be reasonable as a systemic antibiotic therapy, while vancomycin + gentamicin could be implemented in local antibiotic therapy to reduce adverse events during treatment.

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“…In case of negative culture results, additional reverse-transcriptase polymerase chain reaction (PCR) was carried out. Sonication of the implants was introduced in 2016 and performed as described before [ 17 ]. Initial proof of mono- and polymicrobial infections was determined.…”

Section: Methodsmentioning

confidence: 99%

Surgical treatment outcome after serial debridement of infected nonunion—A retrospective cohort study

Rupp

Kern

Walter

et al. 2021

Eur J Orthop Surg Traumatol

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Purpose Reported outcome after multiple staged surgical treatment of infected nonunion is scarce. We, therefore, asked: (1) What is the clinical outcome in infected nonunion patients after multiple staged revision surgery? (2) Are different pathogens evidenced after surgical treatment in patients who have undergone more or less surgeries? Methods All enrolled patients were surgically treated for long bone-infected nonunion between January 2010 and March 2018. Besides patients´ demographics outcome in terms of bony consolidation and major complications defined as death during inward treatment, amputation and recurrence of infection during follow-up of at least 12 months were assessed. Microbiological findings were assessed and compared between two groups with less than five versus five or more surgical revisions. Results Bone consolidation was achieved in 86% of the patients while complications such as femoral or transtibial amputation, recurrence of infection or even death during inpatient treatment could be evidenced in six patients (14%). In patients who underwent multiple-stage surgery for five or more times, germ changes and repeated germ detection was more common than in patients with less surgeries. Conclusions Surgical treatment of infected nonunions poses a high burden on the patients with major complications occurring in about 14% of the patients using a multiple staged treatment concept. Future prospective studies comparing outcomes after limited with multiple staged revision surgeries are necessary.

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Polymicrobial infections and microbial patterns in infected nonunions – a descriptive analysis of 42 cases

Cited by 16 publications

References 26 publications

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

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

What Is the Most Effective Empirical Antibiotic Treatment for Early, Delayed, and Late Fracture-Related Infections?

Surgical treatment outcome after serial debridement of infected nonunion—A retrospective cohort study

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