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Article: Outcomes of fracture-related infections – do organism, depth of involvement, and temporality count?

TitleOutcomes of fracture-related infections – do organism, depth of involvement, and temporality count?
Authors
Keywordsfracture
fracture-related infection
infection
mortality
osteosynthesis
Issue Date22-Dec-2022
PublisherSAGE Publications
Citation
Journal of Orthopaedic Surgery, 2022, v. 30, n. 3 How to Cite?
Abstract

Purpose: To determine mortality and outcomes of patients diagnosed with fracture-related infections (FRIs).

Methods: FRI patients treated at a trauma centre between 2001 and 2020 were analysed. The primary outcome was 1-year mortality; mortality associations with FRI organism, depth of involvement, and temporality were investigated with multivariable survival analysis. Healthcare-associated and serological outcomes were reported as secondary outcomes. Results: 311 FRIs with mean age of 67.0 and median Charlson comorbidity index of 0 were analysed. Methicillin-sensitive Staphylococcus aureus (MSSA) (29.9%) was the most frequently implicated organism. The majority of FRIs were deep infections (62.7%). FRIs were diagnosed at a median of 40 (IQR 15–200) days post index surgery. The mean follow-up was 5.9 years. One-year mortality amounted to 17.7%. MSSA FRIs were associated with better survival (adj HR 0.34, 95%CI 0.15–0.76, p = 0.008). There was no difference in survivorship between deep or superficial FRI (adj HR 0.86, 95%CI 0.62–1.19, p = 0.353) or in relation to onset time (adj HR 1.0, 95%CI 0.99–1.00, p = 0.943). Implant removal or debridement alone was performed in 61.7% and 17% respectively. Antibiotics was prescribed for 53 (IQR 23–110) days, and patients were hospitalised for 39 (IQR 19–78) days. CRP and ESR normalised in 70.3% (median 46 days) and 53.8% (median 86 days) patients respectively. Conclusion: Fracture-related infections are associated with significant mortality and morbidity regardless of depth and temporality. Non-MSSA FRIs are associated with inferior survival.


Persistent Identifierhttp://hdl.handle.net/10722/338868
ISSN
2023 Impact Factor: 1.3
2023 SCImago Journal Rankings: 0.557
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorWong, JSH-
dc.contributor.authorLee, ALH-
dc.contributor.authorFang, CS-
dc.contributor.authorLeung, HCH-
dc.contributor.authorLiu, AHY-
dc.contributor.authorSo, RCK-
dc.contributor.authorYung, CSY-
dc.contributor.authorWong, TM-
dc.contributor.authorLeung, F-
dc.date.accessioned2024-03-11T10:32:08Z-
dc.date.available2024-03-11T10:32:08Z-
dc.date.issued2022-12-22-
dc.identifier.citationJournal of Orthopaedic Surgery, 2022, v. 30, n. 3-
dc.identifier.issn1022-5536-
dc.identifier.urihttp://hdl.handle.net/10722/338868-
dc.description.abstract<p><strong>Purpose:</strong> To determine mortality and outcomes of patients diagnosed with fracture-related infections (FRIs).</p><p><strong>Methods:</strong> FRI patients treated at a trauma centre between 2001 and 2020 were analysed. The primary outcome was 1-year mortality; mortality associations with FRI organism, depth of involvement, and temporality were investigated with multivariable survival analysis. Healthcare-associated and serological outcomes were reported as secondary outcomes. <strong>Results:</strong> 311 FRIs with mean age of 67.0 and median Charlson comorbidity index of 0 were analysed. Methicillin-sensitive <em>Staphylococcus aureus</em> (MSSA) (29.9%) was the most frequently implicated organism. The majority of FRIs were deep infections (62.7%). FRIs were diagnosed at a median of 40 (IQR 15–200) days post index surgery. The mean follow-up was 5.9 years. One-year mortality amounted to 17.7%. MSSA FRIs were associated with better survival (adj HR 0.34, 95%CI 0.15–0.76, <em>p</em> = 0.008). There was no difference in survivorship between deep or superficial FRI (adj HR 0.86, 95%CI 0.62–1.19, <em>p</em> = 0.353) or in relation to onset time (adj HR 1.0, 95%CI 0.99–1.00, <em>p</em> = 0.943). Implant removal or debridement alone was performed in 61.7% and 17% respectively. Antibiotics was prescribed for 53 (IQR 23–110) days, and patients were hospitalised for 39 (IQR 19–78) days. CRP and ESR normalised in 70.3% (median 46 days) and 53.8% (median 86 days) patients respectively. <strong>Conclusion:</strong> Fracture-related infections are associated with significant mortality and morbidity regardless of depth and temporality. Non-MSSA FRIs are associated with inferior survival.</p>-
dc.languageeng-
dc.publisherSAGE Publications-
dc.relation.ispartofJournal of Orthopaedic Surgery-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectfracture-
dc.subjectfracture-related infection-
dc.subjectinfection-
dc.subjectmortality-
dc.subjectosteosynthesis-
dc.titleOutcomes of fracture-related infections – do organism, depth of involvement, and temporality count?-
dc.typeArticle-
dc.identifier.doi10.1177/10225536221118519-
dc.identifier.scopuseid_2-s2.0-85144598640-
dc.identifier.volume30-
dc.identifier.issue3-
dc.identifier.eissn2309-4990-
dc.identifier.isiWOS:000928088000001-
dc.identifier.issnl1022-5536-

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