Effect of a standardized treatment regime for infection after osteosynthesis
Effect of a standardized treatment regime for infection after osteosynthesis
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DOI：
10.1186/s13018-017-0535-x
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发表时间：
2017-03-09
影响因子：
2.6
通讯作者：
Hietbrink, Falco
中科院分区：
文献类型：
--
作者：
Hellebrekers, Pien;Leenen, Luke P. H.;Hietbrink, Falco
背景：接骨术后感染是一种重要的并发症，具有显着的发病率甚至死亡率。这些感染通常是由产生生物膜的细菌引起的。治疗算法规定采用手术清创和抗生素治疗的积极方法。本研究的目的是分析这种积极的标准化治疗方案（保留种植体）对于接骨术后急性、现有的 < 3 周感染的效果。 方法：我们在单个 1 级创伤中心对任何接骨手术后 12 个月内发生的感染进行了为期 2 年的回顾性队列研究。标准化治疗方案包括种植体保留、彻底的手术清创以及立即使用利福平进行抗生素联合治疗。主要结果是成功。成功的定义是骨折的巩固和感染症状的解决。进行培养和药敏试验来鉴定细菌和耐药模式。对与初次成功和抗生素耐药性相关的患者相关因素进行单变量分析。结果：纳入了 49 名患者进行分析。初次成功率为 63%，总体成功率为 88%。与初次成功负相关的因素如下：Gustilo 分类（P = 0.023）、所需清创次数较多（P = 0.015）、无法初次闭合（P = 0.017）以及随后应用真空治疗（P = 0.030）。坚持治疗方案与初次成功呈正相关（P = 0.034）。结论：所描述的治疗方案具有很高的成功率，与假体关节感染治疗中分阶段交换所取得的成功率相当。
Background: Infection after osteosynthesis is an important complication with significant morbidity and even mortality. These infections are often caused by biofilm-producing bacteria. Treatment algorithms dictate an aggressive approach with surgical debridement and antibiotic treatment. The aim of this study is to analyze the effect of such an aggressive standardized treatment regime with implant retention for acute, existing < 3 weeks, infection after osteosynthesis.Methods: We conducted a retrospective 2-year cohort in a single, level 1 trauma center on infection occurring within 12 months following any osteosynthesis surgery. The standardized treatment regime consisted of implant retention, thorough surgical debridement, and immediate antibiotic combination therapy with rifampicin. The primary outcome was success. Success was defined as consolidation of the fracture and resolved symptoms of infection. Culture and susceptibility testing were performed to identify bacteria and resistance patterns. Univariate analysis was conducted on patient-related factors in association with primary success and antibiotic resistance.Results: Forty-nine patients were included for analysis. The primary success rate was 63% and overall success rate 88%. Factors negatively associated with primary success were the following: Gustilo classification (P = 0.023), higher number of debridements needed (P = 0.015), inability of primary closure (P = 0.017), and subsequent application of vacuum therapy (P = 0.030). Adherence to the treatment regime was positively related to primary success (P = 0.034).Conclusions: The described treatment protocol results in high success rates, comparable with success rates achieved in staged exchange in prosthetic joint infection treatment.