AO Research Institute Davos, Davos, Switzerland.
Faculty of Science and Engineering, Queensland University of Technology (QUT), Brisbane, Australia.
Expert Rev Anti Infect Ther. 2020 Apr;18(4):307-321. doi: 10.1080/14787210.2020.1729740. Epub 2020 Feb 19.
: Fracture-related infection (FRI) is a serious complication related to orthopedic trauma, both from an infectious disease and a surgical point of view. The lack of scientific data with respect to diagnostic criteria and treatment principles of this entity has hampered efforts for an evidence-based approach and, as such, practices to prevent and treat FRI are often extrapolated from peri-prosthetic joint infection (PJI) literature. Recently, consensus guidelines were developed with respect to prevention, diagnosis and treatment of FRI.: This review will define FRI and approaches to prevent and treat this complication will be discussed, with an emphasis on antimicrobial and surgical considerations. Guidelines focusing on FRI will be highlighted and aspects of pre-clinical research with imminent translational potential described.: New strategies are currently under investigation to improve the outcome of this sometimes-devastating complication. Local delivery of antimicrobials seems to be a promising approach; however, further high-quality clinical research is necessary to demonstrate efficacy. Delivery mechanisms for local antimicrobials include polymethyl methacrylate, implant coatings, collagen fleece, hydrogels and ceramics. The reintroduction of antimicrobials such as bacteriophage therapy has demonstrated promise in the management of drug-resistant organisms.
骨折相关感染(FRI)是一种与骨科创伤相关的严重感染并发症,从感染病学和外科学的角度来看都是如此。由于缺乏针对该疾病的诊断标准和治疗原则的科学数据,因此妨碍了循证方法的努力,因此,预防和治疗 FRI 的实践通常是从人工关节周围感染(PJI)文献中推断出来的。最近,针对 FRI 的预防、诊断和治疗制定了共识指南:本文将定义 FRI,并讨论预防和治疗这种并发症的方法,重点是抗菌和手术方面的考虑。将重点介绍专门针对 FRI 的指南,并描述具有潜在转化意义的临床前研究的各个方面。目前正在研究新的策略来改善这种有时具有破坏性的并发症的治疗效果。局部抗菌药物的递送似乎是一种很有前途的方法;但是,需要进一步进行高质量的临床研究来证明其疗效。局部抗菌药物的递送机制包括聚甲基丙烯酸甲酯、植入物涂层、胶原绒、水凝胶和陶瓷。噬菌体治疗等抗菌药物的重新引入已在耐药菌的治疗管理中显示出前景。