Fracture-related infections in HIV infected patients: A systematic review and meta-analysis

Luan Nieuwoudt; Reitze N Rodseth; Leonard Charles Marais

doi:10.1016/j.jor.2020.01.023

Fracture-related infections in HIV infected patients: A systematic review and meta-analysis

J Orthop. 2020 Jan 30:18:248-254. doi: 10.1016/j.jor.2020.01.023. eCollection 2020 Mar-Apr.

Authors

Luan Nieuwoudt¹, Reitze N Rodseth^{2

3}, Leonard Charles Marais⁴

Affiliations

¹ Tumour, Sepsis & Reconstruction Unit, Grey's Hospital, Pietermaritzburg, 3201, KwaZulu-Natal, South Africa.
² Department Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, Pietermaritzburg, South Africa.
³ Jones, Bhagwan and Partners, Pietermaritzburg, South Africa.
⁴ Department Orthopaedics, School of Clinical Medicine, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.

Abstract

Aim: To conduct a systematic review and meta-analysis comparing the incidence of fracture-related infections (FRI) following surgical management of closed and open fractures in HIV-positive and HIV-negative patients.

Methods: A systematic literature search was conducted using MEDLINE, ProQuest, Web of Science, The Cochrane Library and Scopus. Our own files and reference lists of identified key articles were also searched. We included studies where the primary outcome was the development of FRI in patients with open and closed fractures.

Results: Eleven studies were included for data synthesis. HIV-positive patients had a non-significant increase in FRI when compared to HIV-negative patients (in open and closed fractures combined). Open fractures treated in the pre-antiretroviral era had a 5.6 times greater risk for developing a FRI. In the post-antiretroviral era (1997 onwards) HIV-positive patients did not have a greater risk of FRI than HIV-negative patients for both open and closed fractures. The small retrospective natures of these studies, together with the heterogeneous outcome definitions used, are limitations to this study.

Conclusion: While there are few large prospective studies, the available data suggests that before the introduction antiretroviral therapy HIV infection was associated with a greater risk of FRI. In the post-antiretroviral era HIV infected patients did not show an increased risk of FRI.

Keywords: AIDS; Chronic osteomyelitis; Fracture-related infection; HIV; Infection; Post-operative; Post-traumatic infection; Sepsis; Surgical site infection.