Prevention of infection in open fractures: Where are the pendulums now?

Rupp, Markus; Popp, Daniel; Alt, Volker

doi:10.1016/j.injury.2019.10.074

Cited by 66 publications

(47 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The observed trend towards more FRI diagnosis in older patients possibly reflects demographic changes such as population decline and aging, which challenge the healthcare system not only in Germany. In consideration that prevention strategies and improved treatment algorithms for optimal patient care moved into focus of orthopedic research 2 , 10 , 25 , the increase of infection rates over the last decade seems surprisingly high. This might be attributable to heightened prevalence of obesity, which has risen substantially and the fact that Germany is rated among the countries with the highest prevalence of tobacco use in Europe 26 , 27 .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The epidemiology of fracture-related infections in Germany

Walter

Rupp

Lang

et al. 2021

Sci Rep

Self Cite

View full text Add to dashboard Cite

The epidemiology of fracture-related infection (FRI) is unknown, which makes it difficult to estimate future demands and evaluate progress in infection prevention. Therefore, we aimed to determine the nationwide burden’s development over the last decade as a function of age group and gender. FRI prevalence as a function of age group and gender was quantified based on annual ICD-10 diagnosis codes from German medical institutions between 2008 through 2018, provided by the Federal Statistical Office of Germany (Destatis). The prevalence of FRI increased by 0.28 from 8.4 cases per 100,000 inhabitants to 10.7 cases per 100,000 inhabitants between 2008 and 2018. The proportion of fractures resulting in FRI increased from 1.05 to 1.23%. Gender distribution was equal. Patients aged 60–69 years and 70–79 years comprised the largest internal proportion with 20.2% and 20.7%, respectively, whereby prevalence increased with age group. A trend towards more diagnoses in older patients was observed with a growth rate of 0.63 for patients older than 90 years. Increasing rates of fracture-related infection especially in older patients indicate an upcoming challenge for stakeholders in health care systems. Newly emerging treatment strategies, prevention methods and interdisciplinary approaches are strongly required.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Among others, consequences are significantly reduced patient-reported quality of life and multiplied healthcare costs up to 6.5 times 8 , 9 . Hence, much effort has been made in prevention approaches 2 , 10 – 12 .…”

Section: Introductionmentioning

confidence: 99%

The epidemiology of fracture-related infections in Germany

Walter

Rupp

Lang

et al. 2021

Sci Rep

Self Cite

View full text Add to dashboard Cite

show abstract

“…Further, higher numbers of chronic cases compared to acute cases were determined, whereas the prevalence of acute osteomyelitis rose by 61.8%. This finding may be attributable to recent advances in prevention strategies, early diagnosis of low-grade infections or awareness to discriminate acute and chronic bone infections [ 11 , 30 , 31 ]. However, potential biases in the distinction between acute and chronic osteomyelitis might influence these numbers as different definitions exits in the literature [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although joint replacement procedures and surgical fracture treatment with internal fixation devices have become an integral part of modern medicine enhancing patients’ quality of life, they represent an additional risk of bone and joint infection. For instance, rates of developing a posttraumatic infection are reported to be around 1–2% for closed fractures ranging up to exceeding 30% for Gustilo-Anderson type III open tibia fractures despite prevention strategies [ 8 – 11 ]. Depending on injury severity, success rates only vary between 70 and 90% with a recurrence of the disease in 6–9% of the patients [ 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

What is the burden of osteomyelitis in Germany? An analysis of inpatient data from 2008 through 2018

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background The epidemiology of osteomyelitis in Germany is unknown, which makes it difficult to estimate future demands. Therefore, we aimed to analyse how the numbers of cases have developed over the last decade as a function of osteomyelitis subtype, age group, gender, and anatomical localization. Methods Osteomyelitis rates were quantified based on annual ICD-10 diagnosis codes from German medical institutions between 2008 through 2018, provided by the Federal Statistical Office of Germany (Destatis). Results Overall osteomyelitis prevalence increased by 10.44% from 15.5 to 16.7 cases per 100,000 inhabitants between 2008 through 2018. Out of 11,340 cases in 2018, 47.6% were diagnosed as chronic, 33.2% as acute and 19.2% as unspecified osteomyelitis. Men were often affected than women with 63.4% of all cases compared to 36.6%. The largest proportion of patients comprised the age group 60–69 years (22.1%), followed by 70–79 years (21.7%). A trend towards more osteomyelitis diagnoses in older patients was observed. Lower extremities were most frequently infected with 73.8% of all cases in 2018 (+ 10.8% change). Conclusions Osteomyelitis remains a serious problem for orthopedic and trauma surgery. Prevention methods and interdisciplinary approaches are strongly required.

show abstract

“…1 A recent study showed that once the implant is placed in the body, especially in open fractures, it will significantly increase the possibility of infection. 2 Bacteria that adhere to the surface of the implant will reproduce and produce microbial biofilms. 3,4 In particular, bacterial biofilms are renowned for their enhanced resistance to environmental and chemical stresses such as antibiotics, metal ions, and organic solvents.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic-Loaded MMT/PLL-Based Coating on the Surface of Endosseous Implants to Suppress Bacterial Infections

Yu¹,

Liao²,

Chen³

2021

IJN

View full text Add to dashboard Cite

Background: Bone infections remain one of the most common and serious complications of orthopedic surgery, posing a tremendous economic burden to society and patients. This is because bacteria colonize and multiply on the surface of the implant. The (MMT/PLL) 8 multilayer films have been shown to effectively release antibiotics depending on the changes in the microenvironment. Here, vancomycin was loaded into the (MMT/PLL) 8 multilayer films, which were prepared to be used as a local delivery system for the treatment of bone infections. Methods: We used the layer-by-layer self-assembly method to prepare VA-loaded coatings (MMT/PLL-VA) 8 consisting of montmorillonite (MMT), poly-L-lysine (PLL), and VA. The thickness and surface morphology of coatings were characterized using spectroscopic ellipsometry and scanning electron microscopy (SEM). In order to evaluate the drug release behavior from coatings in different media, we measured the size of the zone of inhibition. Additionally, in vitro antibacterial activity was assessed using the shake-flask culture method and SEM images, while that of in vivo was evaluated by establishing an animal model of bone infection. Results: Our findings revealed that small-molecule antibiotics were successfully loaded into the (MMT/PLL-VA) 8 multilayer film structure during the hierarchical self-assembly process and subsequently the multilayer film structure depicted linear growth behavior. The PLL in the multilayer films was progressively degraded which triggered the VA release when contacted with CMS or bacterial infections. The release of VA from multilayer film structure depends on the concentration changes of CMS. Notably, the multilayer films presented great in vitro cell compatibility. Moreover, the prepared antibacterial multilayer films showed excellent antibacterial property by killing more than 99.99% of S. aureus in 24 h. More importantly, we found that multilayer film exhibits good sterilization effect and biocompatibility under the stimulation of bacterial liquid both in vitro and in vivo antibacterial ability tests. Conclusion:Altogether, this study shows that (MMT/PLL-VA) 8 multilayer films containing CMS and bacteria-responsive drug release properties posess high bactericidal activity and good biocompatibility. This finding provides a novel strategy for the treatment of bone infections.

show abstract

Prevention of infection in open fractures: Where are the pendulums now?

Cited by 66 publications

References 58 publications

The epidemiology of fracture-related infections in Germany

The epidemiology of fracture-related infections in Germany

What is the burden of osteomyelitis in Germany? An analysis of inpatient data from 2008 through 2018

Antibiotic-Loaded MMT/PLL-Based Coating on the Surface of Endosseous Implants to Suppress Bacterial Infections

Contact Info

Product

Resources

About