Fracture-related infection: A consensus on definition from an international expert group
Fracture-related infection: A consensus on definition from an international expert group
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DOI：
10.1016/j.injury.2017.08.040
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发表时间：
2018-03-01
影响因子：
2.5
通讯作者：
Verhofstad, M. H. J.
中科院分区：
文献类型：
--
作者：
Metsemakers, W. J.;Morgenstern, M.;Verhofstad, M. H. J.
骨折相关感染（FRI）是创伤外科中一种常见且严重的并发症。由于缺乏明确的定义，准确评估这种并发症的影响一直受阻。FRI缺乏有效的定义使得现有研究难以评估或比较。为了解决这一问题，在AO基金会的支持下，由多个科学和医学组织组成的专家组召开会议，以制定一个共识性定义。
导致这一提议定义的过程始于一项系统的文献综述，该综述显示，大多数骨折治疗的随机对照试验没有使用FRI的标准化定义。针对这一结论，在所有注册的AOTrauma用户中开展了一项关于FRI定义的需求及关键组成部分的国际调查。在回复的2000多名外科医生中，约90%认为需要FRI的定义。作为最后一步，与一个专家小组举行了共识会议。这一过程的结果产生了FRI的共识性定义。
定义了诊断特征的两个确定程度级别。标准可以是确诊性的（肯定存在感染）或提示性的。确定了四个确诊标准：瘘管、窦道或伤口破溃；伤口脓性引流或手术期间存在脓液；从至少两个独立的深部组织/植入物标本培养鉴定出表型无法区分的病原体；通过组织病理学检查证实，在手术干预期间获取的深部组织中存在微生物。此外，还定义了一系列提示性标准。这些需要进一步调查以寻找确诊标准。
在本文中，对提议的定义进行了概述，并阐述了每个组成部分和决策的依据。建立FRI定义的目的是为临床医生提供标准化临床报告的机会，并提高已发表文献的质量。需要注意的是，提议的定义并非旨在指导FRI的治疗，且未来应通过前瞻性数据收集进行验证。（C）2017作者。由爱思唯尔有限公司出版。
Fracture-related infection (FRI) is a common and serious complication in trauma surgery. Accurately estimating the impact of this complication has been hampered by the lack of a clear definition. The absence of a working definition of FRI renders existing studies difficult to evaluate or compare. In order to address this issue, an expert group comprised of a number of scientific and medical organizations has been convened, with the support of the AO Foundation, in order to develop a consensus definition.The process that led to this proposed definition started with a systematic literature review, which revealed that the majority of randomized controlled trials in fracture care do not use a standardized definition of FRI. In response to this conclusion, an international survey on the need for and key components of a definition of FRI was distributed amongst all registered AOTrauma users. Approximately 90% of the more than 2000 surgeons who responded suggested that a definition of FRI is required. As a final step, a consensus meeting was held with an expert panel. The outcome of this process led to a consensus definition of FRI.Two levels of certainty around diagnostic features were defined. Criteria could be confirmatory (infection definitely present) or suggestive. Four confirmatory criteria were defined: Fistula, sinus or wound breakdown; Purulent drainage from the wound or presence of pus during surgery; Phenotypically indistinguishable pathogens identified by culture from at least two separate deep tissue/implant specimens; Presence of microorganisms in deep tissue taken during an operative intervention, as confirmed by histopathological examination. Furthermore, a list of suggestive criteria was defined. These require further investigations in order to look for confirmatory criteria.In the current paper, an overview is provided of the proposed definition and a rationale for each component and decision. The intention of establishing this definition of FRI was to offer clinicians the opportunity to standardize clinical reports and improve the quality of published literature. It is important to note that the proposed definition was not designed to guide treatment of FRI and should be validated by prospective data collection in the future. (C) 2017 The Author(s). Published by Elsevier Ltd.