Sliepen Jonathan, Corrigan Ruth A, Dudareva Maria, Wouthuyzen-Bakker Marjan, Rentenaar Rob J, Atkins Bridget L, Govaert Geertje A M, McNally Martin A, IJpma Frank F A
Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands.
Department of Infectious Diseases, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford OX3 9DU, UK.
Antibiotics (Basel). 2022 Sep 29;11(10):1330. doi: 10.3390/antibiotics11101330.
This international, multi-center study evaluated the effect of antibiotic-loaded carriers (ALCs) on outcome in patients with a fracture-related infection (FRI) and evaluated whether bacterial resistance to the implanted antibiotics influences their efficacy. All patients who were retrospectively diagnosed with FRI according to the FRI consensus definition, between January 2015 and December 2019, and who underwent surgical treatment for FRI at any time point after injury, were considered for inclusion. Patients were followed-up for at least 12 months. The primary outcome was the recurrence rate of FRI at follow-up. Inverse probability for treatment weighting (IPTW) modeling and multivariable regression analyses were used to assess the relationship between the application of ALCs and recurrence rate of FRI at 12 months and 24 months. Overall, 429 patients with 433 FRIs were included. A total of 251 (58.0%) cases were treated with ALCs. Gentamicin was the most frequently used antibiotic (247/251). Recurrence of infection after surgery occurred in 25/251 (10%) patients who received ALCs and in 34/182 (18.7%) patients who did not (unadjusted hazard ratio (uHR): 0.48, 95% CI: [0.29-0.81]). Resistance of cultured microorganisms to the implanted antibiotic was not associated with a higher risk of recurrence of FRI (uHR: 0.75, 95% CI: [0.32-1.74]). The application of ALCs in treatment of FRI is likely to reduce the risk of recurrence of infection. The high antibiotic concentrations of ALCs eradicate most pathogens regardless of susceptibility test results.
这项国际多中心研究评估了载抗生素载体（ALCs）对骨折相关感染（FRI）患者预后的影响，并评估了细菌对植入抗生素的耐药性是否会影响其疗效。所有在2015年1月至2019年12月期间根据FRI共识定义被回顾性诊断为FRI，且在受伤后任何时间点接受FRI手术治疗的患者均被纳入研究。患者随访至少12个月。主要结局是随访时FRI的复发率。采用治疗权重逆概率（IPTW）建模和多变量回归分析来评估ALCs的应用与12个月和24个月时FRI复发率之间的关系。总体而言，纳入了429例患有433处FRI的患者。共有251例（58.0%）病例接受了ALCs治疗。庆大霉素是最常用的抗生素（247/251）。接受ALCs治疗的251例患者中有25例（10%）术后感染复发，未接受ALCs治疗的182例患者中有34例（18.7%）感染复发（未调整风险比（uHR）：0.48，95%置信区间：[0.29 - 0.81]）。培养微生物对植入抗生素的耐药性与FRI复发风险较高无关（uHR：0.75，95%置信区间：[0.32 - 1.74]）。ALCs应用于FRI治疗可能会降低感染复发风险。无论药敏试验结果如何，ALCs的高抗生素浓度可根除大多数病原体。
