Department of Surgery, University Medical Center Utrecht, P.O. Box 85500, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Eur J Trauma Emerg Surg. 2020 Dec;46(6):1341-1350. doi: 10.1007/s00068-019-01182-6. Epub 2019 Jul 16.
Infection near metal implants is a problem that presents challenging treatment dilemmas for physicians. The aim of this study was to analyse the efficacy of two treatment protocols for acute fracture-related infections.
Seventy-one patients in two level-1 trauma centres in the Netherlands were retrospectively included in this study. These trauma centres had different standardised protocols for acute infection after osteosynthesis: 39 patients were selected from protocol A and 32 from protocol B. Both protocols involve immediate surgical debridement and soft tissue coverage, but differ in antibiotic approach: (A) immediate empirical combination antibiotic therapy with rifampicin, or (B) postponed (1-5 days) targeted antibiotic therapy. The primary outcome of these protocols was success, defined as a fracture healing in the absence of infection. The secondary outcome was antibiotic resistance patterns. Logistic regression was conducted on patients and treatment-related factors in association with primary success.
Primary success was achieved in 72% of protocol A patients, in 47% of those in protocol B (P = 0.033), and with prolongation of treatment success was achieved in 90% and 78% of patients, respectively. Protocol A exhibited a better primary success rate (adjusted OR 3.45, CI 1.13-10.52) when adjusted for age and soft tissue injury. There was no significant difference in antibiotic resistance between the two protocols.
Both protocols yielded high overall success rates. Immediate empirical antibiotics can be used safely without additional bacterial resistance and may contribute to increased success rates.
金属植入物附近感染是医生面临的具有挑战性的治疗难题。本研究旨在分析两种治疗急性骨折相关感染方案的疗效。
本研究回顾性纳入荷兰 2 个 1 级创伤中心的 71 例患者。这两个创伤中心对于骨内固定术后急性感染有不同的标准化方案：39 例患者选自方案 A，32 例选自方案 B。两种方案均涉及立即清创和软组织覆盖，但抗生素治疗方法不同：（A）立即经验性联合抗生素治疗，包括利福平，或（B）延迟（1-5 天）靶向抗生素治疗。这些方案的主要结局是成功，定义为无感染的骨折愈合。次要结局是抗生素耐药模式。对患者和与治疗相关的因素进行逻辑回归，与主要成功相关。
方案 A 患者的主要成功率为 72%，方案 B 患者为 47%（P=0.033），延长治疗后成功率分别为 90%和 78%。方案 A 在调整年龄和软组织损伤因素后，主要成功率更高（调整后的 OR 3.45，95%CI 1.13-10.52）。两种方案的抗生素耐药性无显著差异。
两种方案的总体成功率均较高。立即使用经验性抗生素治疗安全，不会增加细菌耐药性，可能有助于提高成功率。
