Outcomes of fracture-related infections – do organism, depth of involvement, and temporality count?

• Published in: Journal of Orthopaedic Surgery Vol. 30; no. 3; p. 10225536221118519
• Main Authors: Wong, Janus S H, Lee, Alfred L H, Fang, Christian, Leung, Henry C H, Liu, Alicia H Y, So, Ryan C K, Yung, Colin S Y, Wong, Tak-Man, Leung, Frankie
• Format: Book Review Journal Article
• Language: English
• Published: London, England SAGE Publications 01-09-2022; Sage Publications Ltd; SAGE Publishing
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; Fractures, Bone; Humans; Infections; Methicillin; Mortality; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Survival analysis; mortality; infection; osteosynthesis; fracture-related infection; fracture
• ISSN: 1022-5536; 2309-4990
• DOI: 10.1177/10225536221118519

Purpose: To determine mortality and outcomes of patients diagnosed with fracture-related infections (FRIs).
Methods: FRI patients treated at a trauma centre between 2001 and 2020 were analysed. The primary outcome was 1-year mortality; mortality associations with FRI organism, depth of involvement, and temporality were investigated with multivariable survival analysis. Healthcare-associated and serological outcomes were reported as secondary outcomes. Results: 311 FRIs with mean age of 67.0 and median Charlson comorbidity index of 0 were analysed. Methicillin-sensitive Staphylococcus aureus (MSSA) (29.9%) was the most frequently implicated organism. The majority of FRIs were deep infections (62.7%). FRIs were diagnosed at a median of 40 (IQR 15–200) days post index surgery. The mean follow-up was 5.9 years. One-year mortality amounted to 17.7%. MSSA FRIs were associated with better survival (adj HR 0.34, 95%CI 0.15–0.76, p = 0.008). There was no difference in survivorship between deep or superficial FRI (adj HR 0.86, 95%CI 0.62–1.19, p = 0.353) or in relation to onset time (adj HR 1.0, 95%CI 0.99–1.00, p = 0.943). Implant removal or debridement alone was performed in 61.7% and 17% respectively. Antibiotics was prescribed for 53 (IQR 23–110) days, and patients were hospitalised for 39 (IQR 19–78) days. CRP and ESR normalised in 70.3% (median 46 days) and 53.8% (median 86 days) patients respectively. Conclusion: Fracture-related infections are associated with significant mortality and morbidity regardless of depth and temporality. Non-MSSA FRIs are associated with inferior survival.