Department of Trauma Surgery, University Medical Centre Utrecht, University of Utrecht, Utrecht, The Netherlands.
Department of Trauma Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Injury. 2022 Dec;53(12):3930-3937. doi: 10.1016/j.injury.2022.10.017. Epub 2022 Oct 18.
Early Fracture-Related Infections (FRIs) are a common entity in hospitals treating trauma patients and are often treated with a Debridement, Antibiotics and Implant Retention (DAIR) procedure. Aims of this study were to 1) evaluate the recurrence rate after DAIR procedures for early onset FRI, 2) establish the number of surgical procedures to gain control of the initial infection and 3) identify independent predictors for recurrence in this cohort.
A retrospective multicentre cohort study was conducted in two level 1 trauma centres. Consecutive patients who underwent a DAIR procedure between January 1st 2015 and July 1st 2020 for confirmed FRI with an onset of <6 weeks after the latest osseous operation were included. Recorded data included patient demographics, treatment characteristics and follow-up. Univariate and multivariate logistic regression analyses were performed to assess predictors for recurrent FRI.
A total of 141 patients with early FRI were included in this study with a median age of 54.0 years (interquartile range (IQR) 34.5-64.0). The recurrence rate of FRI was 13% (n = 19) at one year follow-up and 18% (n = 25) at 23.1 months (IQR 15.3-36.4) follow-up. Infection control was achieved in 94% (n = 127/135) of cases. In total, 73 patients (52%) underwent at least two surgical procedures to treat the ongoing initial episode of FRI, of whom 54 patients (74%) required two to three procedures and 17 patients (23%) four to five procedures. Predictors for recurrent FRI were use of an intramedullary nail during index operation (odds ratio (OR) 4.0 (95% confidence interval (CI) 1.1-13.8)), need for additional surgical procedures to treat ongoing infection during the treatment period following the first presentation of early FRI (OR 1.9 (95% CI 1.1-3.5)) and a decreased Injury Severity Score (ISS) (inverted OR 1.1 (95% CI 1.0-1.1)).
The recurrence rate after treatment of early onset FRI in patients treated with a DAIR procedure was 18% at 23.1 months follow-up. At least two surgical procedures to gain control of the initial infection were needed in 52% of patients. Independent predictors for recurrent FRI were the use of an intramedullary nail during index operation, need for additional surgical procedures and a decreased ISS.
在治疗创伤患者的医院中，早期与骨折相关的感染（FRIs）是一种常见的疾病，通常采用清创、抗生素和保留植入物（DAIR）手术进行治疗。本研究的目的是：1）评估早期 FRIs 采用 DAIR 手术后的复发率；2）确定获得初始感染控制所需的手术次数；3）确定该队列中复发的独立预测因素。
本研究为回顾性多中心队列研究，在两个 1 级创伤中心进行。纳入 2015 年 1 月 1 日至 2020 年 7 月 1 日期间因早期 FRIs 而接受 DAIR 手术的连续患者，这些患者的 FRIs 确诊于最晚一次骨操作后 6 周内发作。记录的数据包括患者的人口统计学特征、治疗特征和随访情况。采用单变量和多变量逻辑回归分析评估 FRIs 复发的预测因素。
本研究共纳入 141 例早期 FRIs 患者，中位年龄为 54.0 岁（四分位距 34.5-64.0）。在 1 年随访时，FRIs 的复发率为 13%（n=19），在 23.1 个月（四分位距 15.3-36.4）随访时，复发率为 18%（n=25）。94%（n=127/135）的病例感染得到控制。在总共 135 例患者中，有 73 例（52%）至少进行了两次手术来治疗持续的初始 FRIs 发作，其中 54 例（74%）需要进行 2-3 次手术，17 例（23%）需要进行 4-5 次手术。FRIs 复发的预测因素包括在指数手术中使用髓内钉（比值比（OR）4.0（95%置信区间（CI）1.1-13.8））、在首次出现早期 FRIs 后的治疗期间需要额外的手术来治疗持续感染（OR 1.9（95% CI 1.1-3.5））和降低的损伤严重程度评分（ISS）（OR 1.1（95% CI 1.0-1.1））。
在采用 DAIR 手术治疗的患者中，早期 FRIs 治疗后 23.1 个月的复发率为 18%。52%的患者需要至少两次手术来获得初始感染的控制。FRIs 复发的独立预测因素包括指数手术中使用髓内钉、需要额外的手术以及降低的 ISS。
