Abstract
ObjectiveThis study aimed to explore the epidemiological and microbiological characteristics of fracture-related infection (FRI), analyze the drug resistance characteristics of major pathogens, and provide timely and relatively complete clinical and microbiological data for antimicrobial treatment of FRI.MethodsThe clinical and microbiological data of patients with FRI from January 1, 2011, to December 31, 2020, were collected from three tertiary hospitals in Northeast China. The automatic microbial analysis system was used for strain identification and drug susceptibility testing, and the drug susceptibility results were determined in accordance with the latest Clinical and Laboratory Standards Institute (CLSI) criteria (as applicable each year).ResultsA total of 744 patients with FRI were enrolled. The incidence of FRI was about 1.5%, and 81.7% were male patients, with an average age of 48.98 ± 16.01 years. Open fractures accounted for 64.8%. Motor crush (32.8%) and falling (29.8%) were the main causes of injuries. The common sites of infection were the tibia and fibula (47.6%), femur (11.8%), foot (11.8%), and hand (11.6%). A total of 566 pathogenic bacteria were cultured in 378 patients with positive bacterial cultures, of which 53.0% were Gram-positive bacteria and 47.0% were Gram-negative bacteria. The most common pathogen at all sites of infection is Staphylococcus aureus. Staphylococcus aureus had a high resistance rate to penicillin (PEN), erythromycin (ERY), and clindamycin (CLI), exceeding 50%. Methicillin-resistant Staphylococcus aureus (MRSA) was more than 80% resistant to CLI and ERY.ConclusionsThe incidence of FRI in Northeast China was at a low level among major medical centers nationwide. Staphylococcus aureus was still the main pathogen causing bone infections, and the proportion of MRSA was lower than reported abroad, but we have observed an increase in the proportion of infections. Enterobacteriaceae have a higher resistance rate to third-generation cephalosporins and quinolones. For Enterobacteriaceae, other sensitive treatment drugs should be selected clinically.
Highlights
In recent years, with the rapid development of China’s economy, the number of patients with open injury and multiple fractures caused by road and industrial accidents has increased dramatically [1]
This study explores the epidemiological and microbiological characteristics of patients with fracture-related infection (FRI) and analyzes the characteristics of drug-resistant bacteria spectrum of main pathogens
This study reviewed the medical records of patients hospitalized for fractures from January 1, 2011, to December 31, 2020, and selected cases of patients with FRI that met the inclusion criteria, including gender, age, injury factors, infection site, comorbidities, bacterial culture, and drug sensitivity test results
Summary
With the rapid development of China’s economy, the number of patients with open injury and multiple fractures caused by road and industrial accidents has increased dramatically [1]. Open and multiple injuries often cause infection. The total medical cost of infected patients after tibial fracture is 6.5 times that of uninfected patients, antibiotic treatment time is 11 times that of uninfected patients, and the hospital stay is 7.7 times that of uninfected patients [2]. The risk of fracture-related infection (FRI) depends on the location of the injury, severity, and the accompanying injury and physiological state of the host. FRI is usually caused by exogenous factors such as initial trauma or surgery [5]
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