Giordano Vincenzo, Giannoudis Peter V
Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º Andar, Gávea, Rio de Janeiro 22430-160, RJ, Brazil.
Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds LS2 9LU, UK.
J Clin Med. 2024 Sep 27;13(19):5779. doi: 10.3390/jcm13195779.
Fracture-related infection (FRI) is a devastating event, directly affecting fracture healing, impairing patient function, prolonging treatment, and increasing healthcare costs. Time plays a decisive role in prognosis, as biofilm maturation leads to the development of antibiotic resistance, potentially contributing to infection chronicity and increasing morbidity and mortality. Research exploring the association between biofilm maturation and antibiotic resistance in orthopaedics primarily addresses aspects related to quality of life and physical function; however, little exists on life-threatening conditions and mortality. Understanding the intrinsic relationship between biofilm maturation, bacterial resistance, and mortality is critical in all fields of medicine. In the herein narrative review, we summarize recent evidence regarding biofilm formation, antibiotic resistance, and infection chronicity (BARI), the three basic components of the "triangle of death" of FRI, and its implications. Preoperative, perioperative, and postoperative prevention strategies to avoid the "triangle of death" of FRI are presented and discussed. Additionally, the importance of the orthopaedic trauma surgeon in understanding new tools to combat infections related to orthopaedic devices is highlighted.
骨折相关感染（FRI）是一种灾难性事件，直接影响骨折愈合、损害患者功能、延长治疗时间并增加医疗成本。时间在预后中起决定性作用，因为生物膜成熟会导致抗生素耐药性的产生，这可能会导致感染慢性化并增加发病率和死亡率。探索骨科中生物膜成熟与抗生素耐药性之间关联的研究主要关注与生活质量和身体功能相关的方面；然而，关于危及生命的情况和死亡率的研究却很少。了解生物膜成熟、细菌耐药性和死亡率之间的内在关系在医学的各个领域都至关重要。在本文的叙述性综述中，我们总结了关于生物膜形成、抗生素耐药性和感染慢性化（BARI）的最新证据，这是FRI“死亡三角”的三个基本组成部分及其影响。本文还介绍并讨论了术前、围手术期和术后预防策略，以避免FRI的“死亡三角”。此外，强调了骨科创伤外科医生了解对抗与骨科器械相关感染的新工具的重要性。
