Metsemakers W J, Morgenstern M, McNally M A, Moriarty T F, McFadyen I, Scarborough M, Athanasou N A, Ochsner P E, Kuehl R, Raschke M, Borens O, Xie Z, Velkes S, Hungerer S, Kates S L, Zalavras C, Giannoudis P V, Richards R G, Verhofstad M H J
Department of Trauma Surgery, University Hospitals Leuven, Belgium; KU Leuven - University of Leuven, Department Development and Regeneration, B-3000 Leuven, Belgium.
Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Switzerland.
Injury. 2018 Mar;49(3):505-510. doi: 10.1016/j.injury.2017.08.040. Epub 2017 Aug 24.
Fracture-related infection (FRI) is a common and serious complication in trauma surgery. Accurately estimating the impact of this complication has been hampered by the lack of a clear definition. The absence of a working definition of FRI renders existing studies difficult to evaluate or compare. In order to address this issue, an expert group comprised of a number of scientific and medical organizations has been convened, with the support of the AO Foundation, in order to develop a consensus definition. The process that led to this proposed definition started with a systematic literature review, which revealed that the majority of randomized controlled trials in fracture care do not use a standardized definition of FRI. In response to this conclusion, an international survey on the need for and key components of a definition of FRI was distributed amongst all registered AOTrauma users. Approximately 90% of the more than 2000 surgeons who responded suggested that a definition of FRI is required. As a final step, a consensus meeting was held with an expert panel. The outcome of this process led to a consensus definition of FRI. Two levels of certainty around diagnostic features were defined. Criteria could be confirmatory (infection definitely present) or suggestive. Four confirmatory criteria were defined: Fistula, sinus or wound breakdown; Purulent drainage from the wound or presence of pus during surgery; Phenotypically indistinguishable pathogens identified by culture from at least two separate deep tissue/implant specimens; Presence of microorganisms in deep tissue taken during an operative intervention, as confirmed by histopathological examination. Furthermore, a list of suggestive criteria was defined. These require further investigations in order to look for confirmatory criteria. In the current paper, an overview is provided of the proposed definition and a rationale for each component and decision. The intention of establishing this definition of FRI was to offer clinicians the opportunity to standardize clinical reports and improve the quality of published literature. It is important to note that the proposed definition was not designed to guide treatment of FRI and should be validated by prospective data collection in the future.
骨折相关感染（FRI）是创伤外科常见且严重的并发症。由于缺乏明确的定义，准确评估这一并发症的影响受到了阻碍。FRI缺乏有效的定义使得现有研究难以评估或比较。为了解决这个问题，在AO基金会的支持下，召集了一个由多个科学和医学组织组成的专家组，以制定一个共识定义。得出该提议定义的过程始于系统的文献综述，结果显示大多数骨折护理方面的随机对照试验并未采用FRI的标准化定义。针对这一结论，向所有注册的AOTrauma用户开展了一项关于FRI定义的必要性及关键要素的国际调查。在回复的2000多名外科医生中，约90%表示需要FRI的定义。最后一步是与一个专家小组举行共识会议。这一过程的结果得出了FRI的共识定义。定义了围绕诊断特征的两个确定程度级别。标准可以是确定性的（明确存在感染）或提示性的。确定了四个确定性标准：瘘管、窦道或伤口破溃；伤口有脓性引流或手术中存在脓液；从至少两份独立的深部组织/植入物标本培养中鉴定出表型无法区分的病原体；手术干预时获取的深部组织中存在微生物，经组织病理学检查证实。此外，还定义了一系列提示性标准。这些需要进一步调查以寻找确定性标准。在本文中，对提议的定义以及每个组成部分和决策的基本原理进行了概述。建立FRI这一定义的目的是为临床医生提供标准化临床报告的机会，并提高已发表文献的质量。需要注意的是，提议定义并非旨在指导FRI的治疗，未来应通过前瞻性数据收集进行验证。
