PMID- 36307267
OWN - NLM
STAT- MEDLINE
DCOM- 20221128
LR  - 20221128
IS  - 1879-0267 (Electronic)
IS  - 0020-1383 (Linking)
VI  - 53
IP  - 12
DP  - 2022 Dec
TI  - Outcome and risk factors for recurrence of early onset fracture-related 
      infections treated with debridement, antibiotics and implant retention: Results 
      of a large retrospective multicentre cohort study.
PG  - 3930-3937
LID - S0020-1383(22)00787-2 [pii]
LID - 10.1016/j.injury.2022.10.017 [doi]
AB  - INTRODUCTION: Early Fracture-Related Infections (FRIs) are a common entity in 
      hospitals treating trauma patients and are often treated with a Debridement, 
      Antibiotics and Implant Retention (DAIR) procedure. Aims of this study were to 1) 
      evaluate the recurrence rate after DAIR procedures for early onset FRI, 2) 
      establish the number of surgical procedures to gain control of the initial 
      infection and 3) identify independent predictors for recurrence in this cohort. 
      METHODS: A retrospective multicentre cohort study was conducted in two level 1 
      trauma centres. Consecutive patients who underwent a DAIR procedure between 
      January 1st 2015 and July 1st 2020 for confirmed FRI with an onset of <6 weeks 
      after the latest osseous operation were included. Recorded data included patient 
      demographics, treatment characteristics and follow-up. Univariate and 
      multivariate logistic regression analyses were performed to assess predictors for 
      recurrent FRI. RESULTS: A total of 141 patients with early FRI were included in 
      this study with a median age of 54.0 years (interquartile range (IQR) 34.5-64.0). 
      The recurrence rate of FRI was 13% (n = 19) at one year follow-up and 18% 
      (n = 25) at 23.1 months (IQR 15.3-36.4) follow-up. Infection control was achieved 
      in 94% (n = 127/135) of cases. In total, 73 patients (52%) underwent at least two 
      surgical procedures to treat the ongoing initial episode of FRI, of whom 54 
      patients (74%) required two to three procedures and 17 patients (23%) four to 
      five procedures. Predictors for recurrent FRI were use of an intramedullary nail 
      during index operation (odds ratio (OR) 4.0 (95% confidence interval (CI) 
      1.1-13.8)), need for additional surgical procedures to treat ongoing infection 
      during the treatment period following the first presentation of early FRI (OR 1.9 
      (95% CI 1.1-3.5)) and a decreased Injury Severity Score (ISS) (inverted OR 1.1 
      (95% CI 1.0-1.1)). CONCLUSION: The recurrence rate after treatment of early onset 
      FRI in patients treated with a DAIR procedure was 18% at 23.1 months follow-up. 
      At least two surgical procedures to gain control of the initial infection were 
      needed in 52% of patients. Independent predictors for recurrent FRI were the use 
      of an intramedullary nail during index operation, need for additional surgical 
      procedures and a decreased ISS.
CI  - Copyright (c) 2022. Published by Elsevier Ltd.
FAU - Buijs, M A S
AU  - Buijs MAS
AD  - Department of Trauma Surgery, University Medical Centre Utrecht, University of 
      Utrecht, Utrecht, The Netherlands.
FAU - van den Kieboom, J
AU  - van den Kieboom J
AD  - Department of Trauma Surgery, University Medical Centre Utrecht, University of 
      Utrecht, Utrecht, The Netherlands.
FAU - Sliepen, J
AU  - Sliepen J
AD  - Department of Trauma Surgery, University Medical Centre Groningen, University of 
      Groningen, Groningen, The Netherlands.
FAU - Wever, K L H
AU  - Wever KLH
AD  - Department of Trauma Surgery, University Medical Centre Utrecht, University of 
      Utrecht, Utrecht, The Netherlands.
FAU - van Breugel, J M
AU  - van Breugel JM
AD  - Department of Trauma Surgery, University Medical Centre Utrecht, University of 
      Utrecht, Utrecht, The Netherlands.
FAU - Hietbrink, F
AU  - Hietbrink F
AD  - Department of Trauma Surgery, University Medical Centre Utrecht, University of 
      Utrecht, Utrecht, The Netherlands.
FAU - IJpma, F F A
AU  - IJpma FFA
AD  - Department of Trauma Surgery, University Medical Centre Groningen, University of 
      Groningen, Groningen, The Netherlands.
FAU - Govaert, G A M
AU  - Govaert GAM
AD  - Department of Trauma Surgery, University Medical Centre Utrecht, University of 
      Utrecht, Utrecht, The Netherlands. Electronic address: 
      G.A.M.govaert@umcutrecht.nl.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20221018
PL  - Netherlands
TA  - Injury
JT  - Injury
JID - 0226040
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Humans
MH  - Middle Aged
MH  - *Prosthesis-Related Infections/drug therapy/surgery
MH  - Debridement/methods
MH  - Anti-Bacterial Agents/therapeutic use
MH  - Cohort Studies
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Risk Factors
OTO - NOTNLM
OT  - DAIR
OT  - Fracture
OT  - Fracture-related infection
OT  - Infection
OT  - Injury severity score
OT  - Outcome
OT  - Posttraumatic osteomyelitis
OT  - Trauma
OT  - Trauma surgery
COIS- Declarations of Competing Interest The authors declare that they have no 
      competing financial interests or personal relationships that could have appeared 
      to influence the work reported in this paper. The authors declare that they did 
      not receive funding for this study.
EDAT- 2022/10/29 06:00
MHDA- 2022/11/29 06:00
CRDT- 2022/10/28 22:04
PHST- 2022/02/19 00:00 [received]
PHST- 2022/10/01 00:00 [revised]
PHST- 2022/10/15 00:00 [accepted]
PHST- 2022/10/29 06:00 [pubmed]
PHST- 2022/11/29 06:00 [medline]
PHST- 2022/10/28 22:04 [entrez]
AID - S0020-1383(22)00787-2 [pii]
AID - 10.1016/j.injury.2022.10.017 [doi]
PST - ppublish
SO  - Injury. 2022 Dec;53(12):3930-3937. doi: 10.1016/j.injury.2022.10.017. Epub 2022 
      Oct 18.