Epidemiological updates of post-traumatic related limb osteomyelitis in china: a 10 years multicenter cohort study.

Abstract

Post-traumatic related limb osteomyelitis (PTRLO) is a complex bone infection. Currently, there are no available microbial data on a national scale that can guide appropriate antibiotic selection, and explore the dynamic changes in dominant pathogens over time. This study aimed to conduct a comprehensive epidemiological analysis of PTRLO in China. The study was approved by the Institutional Research Board (IRB), and 3,526 PTRLO patients were identified from 212,394 traumatic limb fracture patients at 21 hospitals between January 1st, 2008- December 31st, 2017. A retrospective analysis was conducted to investigate the epidemiology of PTRLO, including changes in infection rate (IR), pathogens, infection risk factors, and antibiotic resistance and sensitivity. The IR of PTRLO increased gradually from 0.93%-2.16% (Z=14.392, P<0.001). Monomicrobial infection (MI, 82.6%) was significantly higher than polymicrobial infection (PI, 17.4%) (P<0.001). The IR of Gram-Positive (GP) & Gram-Negative (GN) pathogens showed a significant increase from the lowest 0.41% to the highest 1.15% (GP) or 1.62% (GN), respectively. However, the longitudinal trend of GP versus GN's composition did not show any significance (Z=+/-1.1918, P>0.05). The most prevalent Gram-positive strains were MSSA (17.03%), MRSA (10.46%), E. faecalis (5.19%), and S. epidermidis (4.87%). In contrast, the dominant strains Gram-negative strains were Pseudomonas Aeruginosa (10.92%), E. cloacae (10.34%), E.coli (9.47%), Acinetobacter Baumannii (7.92%) and Klebsiella Pneumoniae (3.33%). In general, the high-risk factors for PI include opened-fracture (odds ratio, 2.223), hypoproteinemia (odds ratio, 2.328), and multiple fractures (odds ratio, 1.465). It is important to note that the antibiotics resistance and sensitivity analysis of the pathogens may be influenced by complications or comorbidities. This study provides the latest data of PTRLO in China and offers trustworthy guidelines for clinical practice. (China Clinical Trials.gov number, ChiCTR1800017597).