Sukpanichyingyong Sermsak, Sae-Jung Surachai, Stubbs David A, Luengpailin Somkiat
Clinical Epidemiology Unit, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Department of Orthopaedics, Khon Kaen Hospital, Khon Kaen, Thailand.
Sci Rep. 2025 Mar 5;15(1):7732. doi: 10.1038/s41598-025-91990-1.
Fracture-related infection (FRI) is a major challenge in orthopaedic trauma. Understanding of the microbial shift with respect to the initial contamination to infection phase is crucial. This study was to examine the wound microbiota associated with FRI in a prospective cohort study of 155 patients with Gustilo-Anderson Type II, IIIA or IIIB open fractures. Tissue samples were systematically collected from all patients during initial surgical debridement. Out of these, patients who developed infection (FRI group, n = 28) had a second tissue sampling during re-debridement. Conversely, patients who achieved normal healing and subsequently received definitive open reduction and internal fixation served as control (NH group, n = 24). Marked differences between all groups were revealed in the 16S rDNA analysis of microbial communities. The species richness was higher in the Pre-FRI group, but bacterial diversity declined significantly in the FRI group after infection onset. In the Pre-FRI and Pre-NH groups, Firmicutes were the dominating phylum, while in the FRI and NH groups, Proteobacteria and Actinobacteria appeared more prevalent, respectively. In Pre-FRI notably abundant Bacillus and Staphylococcus and in FRI, the most pathogens were Enterobacter and Pseudomonas. The NH group maintained balanced microbial diversity. These findings suggest that declining microbiota diversity and shifts towards dominant pathogens in open fracture patients may serve as early indicators of infection risk, with Bacillus potentially emerging as a predictive biomarker for FRI susceptibility.
骨折相关感染（FRI）是骨科创伤领域的一项重大挑战。了解从初始污染到感染阶段的微生物变化至关重要。本研究旨在通过一项前瞻性队列研究，对155例Gustilo-Anderson II型、IIIA型或IIIB型开放性骨折患者的伤口微生物群进行检测。在初次手术清创时，对所有患者进行系统性组织样本采集。其中，发生感染的患者（FRI组，n = 28）在再次清创时进行了第二次组织采样。相反，愈合正常且随后接受确定性切开复位内固定术的患者作为对照组（NH组，n = 24）。微生物群落的16S rDNA分析显示，所有组之间存在显著差异。FRI前组的物种丰富度较高，但感染发生后，FRI组的细菌多样性显著下降。在FRI前组和NH前组中，厚壁菌门是主要门类，而在FRI组和NH组中，变形菌门和放线菌门分别更为普遍。在FRI前组中，芽孢杆菌和葡萄球菌显著丰富，而在FRI组中，最主要的病原体是肠杆菌和假单胞菌。NH组维持了平衡的微生物多样性。这些发现表明，开放性骨折患者微生物群多样性的下降以及向优势病原体的转变可能是感染风险的早期指标，芽孢杆菌可能成为FRI易感性的预测生物标志物。
