Remission rate of implant-related infections following revision surgery after fractures

Abstract

Purpose In contrast to a large amount of epidemiological data regarding the incidence of implant infections after fracture management, surprisingly few have been published concerning the success of their treatment. Methods This was a single-centre cohort study at Geneva University Hospitals from 2000 to 2012 investigating the remission rates of orthopaedic implant infections after fracture repair and associated variables. Results A total of 139 episodes were included: There were 51 women (37 %) and 28 immunosuppressed (20 %) patients with a median age and American Society of Anaesthesiologists (ASA) score of 51 years and 2 points, respectively. The infected implants were plates (n =75, 54 %), nails (24, 17 %), wires (20), screws (10), cerclage cables or wires (3), hip screws (4) or material for spondylodesis (3). A pathogen was identified in 135 (97 %) cases, including Staphylococcus aureus (73, 52 %), coagulase-negative staphylococci (20), streptococci (7) and 19 Gram-negative rods. All patients underwent antibiotic treatment, and 128 (92 %) remained in remission at a median follow-up time of 2.6 years (range one to 13 years). In multivariate logistic regression analysis, the plate infections were significantly associated with lower remission rates [65/75, 87 %, odds ratio ( Conclusions Among all infected and removed orthopaedic implants, plates were associated with slightly lower remission rates, while the overall treatment success exceeded 90 %. The duration of antibiotic therapy did not alter the outcome.

Increased risk of joint failure in hip prostheses infected with Staphylococcus aureus treated with debridement, antibiotics and implant retention compared to Streptococcus

“…Unfortunately, some of the guidelines proposed for deciding on DAIR management of osteoarticular infections, with [1,9] or without implants [10], fail to take into consideration the role of the infecting pathogen (besides its methicillin resistance) [1]. This is surprising in view of data indicating a more difficult eradication of S. aureus compared to Streptococcus spp.…”

Administration of antibiotic agents before intraoperative sampling in orthopedic infections alters culture results

“…Available literature suggests that the clinical remission rate for treatment of culturenegative prosthetic joint infections is the same as for culture-positive cases, 19 but a clinician's ignorance of the causative pathogens may lead to longer duration or broader-spectrum empiric antibiotic therapy compared to cases with known culture results. 24 In this study, we elected not to address the clinical consequences of altered microbiological results because the outcome of orthopedic infections depends on multiple parameters, e.g., removal of infected material, re-implantation procedures, number of debridements, isolated pathogens, 10,25e27 comorbidities, and type of infection (native joint arthritis, 5 infected arthroplasties, 8 infected fracture-devices, 4,6 chronic osteomyelitis, 9 bursitis 12 or soft tissue infections 11 ). Performing a multivariate analysis with this large case-mix is not possible unless we stratify remission analyses into six strata, which would be inordinately complex and lead to comparisons of small groups.…”

Variables associated with remission in spinal surgical site infections

“…As in many field of septic orthopaedic surgery, the number of surgical debridement does not formally influence remission rates, which has been shown for chronic osteomyelitis (23), septic native joint arthritis (24), fracturedevice infections (25), infected open fractures (26), or prosthetic joint infections (27), while all available literature bases on retrospective studies. To the best of our knowledge, there is no randomized prospective trial targeting the number of debridement for outcome remission.…”