Is There a Difference in Microbiological Epidemiology and Effective Empiric Antimicrobial Therapy Comparing Fracture-Related Infection and Periprosthetic Joint Infection? A Retrospective Comparative Study.

Markus Rupp,Volker Alt,Florian Hitzenbichler,Martin Ehrenschwender,Susanne Baertl,Nike Walter

doi:10.3390/antibiotics10080921

Markus Rupp, Volker Alt + Show 4 more

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https://doi.org/10.3390/antibiotics10080921

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Abstract

This study aims to investigate (1) microbial patterns in fracture-related infections (FRIs) in comparison to microbiological patterns of periprosthetic joint infections (PJIs), (2) the identification of effective empiric antibiotic therapy for FRIs and PJIs and (3) analysis of difficult-to-treat (DTT) pathogens. Patients treated for FRIs or PJIs from 2017 to 2020 were evaluated for pathogens detected during treatment. Antibiotic susceptibility profiles were examined with respect to broadly used antibiotics and antibiotic combinations. Resistance rates to rifampicin or fluoroquinolone were determined. A total of 81 patients with PJI and 86 with FRI were included in the study. For FRIs Staphylococcus aureus was the most common infection-causing pathogen (37.4% vs. 27.9% for PJI). Overall, there was no statistical difference in pathogen distribution (p = 0.254). For FRIs, combinations of gentamicin + vancomycin (93.2%), co-amoxiclav + glycopeptide and meropenem + vancomycin (91.9% each) would have been effective for empiric therapy, similar to PJIs. Difficult to treat pathogens were more frequently detectable in PJIs (11.6% vs. 2.3%). Empiric therapy combinations such as gentamicin + vancomycin, co-amoxiclav + glycopeptide or meropenem + vancomycin, are effective antibiotic strategies for both FRI and PJI patients. More DTT pathogens were detectable in PJIs compared to FRIs.

Highlights

Implant-associated infections, such as periprosthetic joint infection (PJI) and fracturerelated infection (FRI), represent a major complication in orthopedic and trauma surgery with a significant socioeconomic burden [1,2]
The purpose of this study was to answer the following questions: (1) What is the microbial epidemiology in a retrospective cohort treated for FRI? (2) Do the evidenced pathogens in FRI patients differ compared to a cohort treated at the same center for PJI? (3) What is the best possible antibiotic treatment for those FRI and PJI cases? (4) How many cases involved difficult-to-treat (DTT) pathogens in FRI and PJI patients?
PJI patients were older than FRI patients (p < 0.001), showed a higher BMI (p = 0.002) and had statistically significant more comorbidities as indexed by the Charlson Comorbidity Index (CCI) (p < 0.001), not according to the ASA score (p = 0.085)

Summary

Introduction

Implant-associated infections, such as periprosthetic joint infection (PJI) and fracturerelated infection (FRI), represent a major complication in orthopedic and trauma surgery with a significant socioeconomic burden [1,2]. Increasing primary arthroplasty procedures will further boost the importance of implant-associated infections [1,3]. Understanding biofilm formation on non-living surfaces as a key element in implant-associated bone infection helped to establish curative treatment strategies, which entail both surgical management and antibiotic therapy [4]. Whether the microbiological epidemiology of FRI is similar to or differs from PJI is unknown, but this knowledge is important for adequate empirical antibiotic treatment. The purpose of this study was to answer the following questions: (1) What is the microbial epidemiology in a retrospective cohort treated for FRI? (2) Do the evidenced pathogens in FRI patients differ compared to a cohort treated at the same center for PJI? (4) How many cases involved difficult-to-treat (DTT) pathogens in FRI and PJI patients? The purpose of this study was to answer the following questions: (1) What is the microbial epidemiology in a retrospective cohort treated for FRI? (2) Do the evidenced pathogens in FRI patients differ compared to a cohort treated at the same center for PJI? (3) What is the best possible antibiotic treatment for those FRI and PJI cases? (4) How many cases involved difficult-to-treat (DTT) pathogens in FRI and PJI patients?

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