R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Department of Surgery, Orthopaedics, USU-Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Injury. 2021 Jun;52(6):1351-1355. doi: 10.1016/j.injury.2021.03.057. Epub 2021 Apr 1.
Infection after fracture fixation is a potentially devastating outcome, and surgical management is frequently unsuccessful at clearing these infections. The purpose of this study is to determine if factors can be identified that are associated with treatment failure after operative management of a deep surgical site infection.
We retrospectively reviewed the billing system at a Level I trauma center between March 2006 and December 2015. We identified 451 patients treated for deep surgical site infection after fracture fixation at our center. A multivariate regression analysis was then performed to evaluate for factors associated with treatment failure.
Mean follow-up was 2.3 years. One hundred fifty-six patients (35%) failed initial surgical management. Risk factors associated with treatment failure included initial culture results positive for polymicrobial organisms (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.0-2.4), removal of implants (OR, 1.9; 95% CI, 1.2-2.9), or Gustilo-Anderson IIIB/IIIC injury (OR, 2.0; 95% CI, 1.1-3.7). Increased body mass index and fulfilling the criteria to have a methicillin-resistant Staphylococcus aureus (MRSA) nasal swab screening showed a trend toward increased risk of failure.
Treatment failure after deep surgical site infection was relatively common. Three distinct factors (polymicrobial infection, removal of implants, and IIIB/C fracture) were associated with failure to eradicate the infection in the first series of surgeries and antibiotics. These data might help guide clinicians as they counsel patients on the risk of treatment failure and might focus efforts to improve treatment toward patients at higher risk of treatment failure.
骨折固定术后感染是一种潜在的破坏性后果，手术治疗常常无法清除这些感染。本研究的目的是确定是否可以识别出与手术治疗深部手术部位感染后治疗失败相关的因素。
我们回顾性地审查了 2006 年 3 月至 2015 年 12 月期间一级创伤中心的计费系统。我们在我们的中心确定了 451 例骨折固定后深部手术部位感染患者。然后进行多变量回归分析，以评估与治疗失败相关的因素。
平均随访时间为 2.3 年。156 例患者（35%）初次手术治疗失败。与治疗失败相关的危险因素包括初始培养结果为多微生物病原体阳性（比值比 [OR]，1.6；95%置信区间 [CI]，1.0-2.4）、去除植入物（OR，1.9；95% CI，1.2-2.9）或 Gustilo-Anderson IIIB/IIIC 损伤（OR，2.0；95% CI，1.1-3.7）。体重指数增加和符合耐甲氧西林金黄色葡萄球菌（MRSA）鼻拭子筛查标准显示出治疗失败风险增加的趋势。
深部手术部位感染后治疗失败较为常见。有三个不同的因素（混合感染、植入物去除和 IIIB/C 骨折）与第一次手术和抗生素治疗中无法根除感染有关。这些数据可能有助于指导临床医生向患者解释治疗失败的风险，并可能将努力集中在治疗风险较高的患者身上，以提高治疗效果。
