Metsemakers Willem-Jan, Onsea Jolien, Neutjens Emilie, Steffens Ester, Schuermans Annette, McNally Martin, Nijs Stefaan
Department of Trauma Surgery, University Hospital Leuven, Leuven, Belgium.
Department Development and Regeneration, KU Leuven - University of Leuven, B-3000, Leuven, Belgium.
Int Orthop. 2017 Dec;41(12):2457-2469. doi: 10.1007/s00264-017-3607-y. Epub 2017 Aug 22.
Fracture-related infection (FRI) remains a challenging complication. It may result in permanent functional loss or even amputation in otherwise healthy patients. For these reasons, it is important to focus attention on prevention. In treatment algorithms for FRI, antibiotic stewardship programmes have already proved their use by means of a multidisciplinary collaboration between microbiologists, surgeons, pharmacists, infectious disease physicians and nursing staff. A similar approach, however, has not been described for infection prevention. As a first step towards achieving a multidisciplinary care package for infection prevention, this review summarises the most recent guidelines published by the World Health Organization (WHO) and US National Institutes of Health Centers for Disease Control and Prevention (CDC), primarily focusing on the musculoskeletal trauma patient. The implementation of these guidelines, together with close collaboration between infection control physicians, surgeons, anaesthesiologists and nursing staff, can potentially have a beneficial effect on the rate of FRI after musculoskeletal trauma surgery. It must be stated that most evidence presented here in support of these guidelines was not obtained from musculoskeletal trauma research. Although most preventive measures described in these studies can be generalised to the musculoskeletal trauma patient, there are still important differences with nontrauma patients that require further attention. Future research should therefore focus more on this very defined patient population and more specifically on FRI prevention.
骨折相关感染（FRI）仍然是一种具有挑战性的并发症。它可能导致原本健康的患者出现永久性功能丧失甚至截肢。出于这些原因，关注预防非常重要。在FRI的治疗算法中，抗生素管理计划已经通过微生物学家、外科医生、药剂师、传染病医生和护理人员之间的多学科合作证明了其作用。然而，尚未有针对感染预防的类似方法的描述。作为实现多学科感染预防护理方案的第一步，本综述总结了世界卫生组织（WHO）和美国国立卫生研究院疾病控制与预防中心（CDC）发布的最新指南，主要关注肌肉骨骼创伤患者。这些指南的实施，以及感染控制医生、外科医生、麻醉医生和护理人员之间的密切合作，可能会对肌肉骨骼创伤手术后的FRI发生率产生有益影响。必须指出的是，这里支持这些指南的大多数证据并非来自肌肉骨骼创伤研究。尽管这些研究中描述的大多数预防措施可以推广到肌肉骨骼创伤患者，但与非创伤患者仍存在重要差异，需要进一步关注。因此，未来的研究应更多地关注这一明确界定的患者群体，更具体地关注FRI预防。
