The Microbiological Etiology of Fracture-Related Infection

Melissa Depypere; Jonathan Sliepen; Jolien Onsea; Yves Debaveye; Geertje A M Govaert; Frank F A IJpma; Werner Zimmerli; Willem-Jan Metsemakers

doi:10.3389/fcimb.2022.934485

The Microbiological Etiology of Fracture-Related Infection

Front Cell Infect Microbiol. 2022 Jul 7:12:934485. doi: 10.3389/fcimb.2022.934485. eCollection 2022.

Authors

Melissa Depypere^{1

2}, Jonathan Sliepen³, Jolien Onsea^{4

5}, Yves Debaveye⁶, Geertje A M Govaert⁷, Frank F A IJpma³, Werner Zimmerli⁸, Willem-Jan Metsemakers^{4

5}

Affiliations

¹ Department of laboratory medicine, University Hospitals Leuven, Leuven, Belgium.
² Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Bacteriology and Mycology, KU Leuven, Leuven, Belgium.
³ Department of Trauma Surgery, University Medical Center Groningen, Groningen, Netherlands.
⁴ Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium.
⁵ Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium.
⁶ Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium.
⁷ Department of Trauma Surgery, University of Utrecht, University Medical Center Utrecht, Utrecht, Netherlands.
⁸ Basel University Medical Clinic, Kantonsspital Baselland, Liestal, Switzerland.

Abstract

Purpose: Fracture-related infection (FRI) is an important complication related to orthopaedic trauma. Although the scientific interest with respect to the diagnosis and treatment of FRI is increasing, data on the microbiological epidemiology remains limited. Therefore, the primary aim of this study was to evaluate the microbiological epidemiology related to FRI, including the association with clinical symptoms and antimicrobial susceptibility data. The secondary aim was to analyze whether there was a relationship between the time to onset of infection and the microbiological etiology of FRI.

Methods: FRI patients treated at the University Hospitals of Leuven, Belgium, between January 1st 2015 and November 24th 2019 were evaluated retrospectively. The microbiological etiology and antimicrobial susceptibility data were analyzed. Patients were classified as having an early (<2 weeks after implantation), delayed (2-10 weeks) or late-onset (> 10 weeks) FRI.

Results: One hundred ninety-one patients with 194 FRIs, most frequently involving the tibia (23.7%) and femur (18.6%), were included. Staphylococcus aureus was the most frequently isolated pathogen, regardless of time to onset (n=61; 31.4%), followed by S. epidermidis (n=50; 25.8%) and non-epidermidis coagulase-negative staphylococci (n=35; 18.0%). Polymicrobial infections (n=49; 25.3%), mainly involving Gram negative bacilli (GNB) (n=32; 65.3%), were less common than monomicrobial infections (n=138; 71.1%). Virulent pathogens in monomicrobial FRIs were more likely to cause pus or purulent discharge (n=45;54.9%; p=0.002) and fistulas (n=21;25.6%; p=0.030). Susceptibility to piperacillin/tazobactam for GNB was 75.9%. Vancomycin covered 100% of Gram positive cocci.

Conclusion: This study revealed that in early FRIs, polymicrobial infections and infections including Enterobacterales and enterococcal species were more frequent. A time-based FRI classification is not meaningful to estimate the microbiological epidemiology and cannot be used to guide empiric antibiotic therapy. Large multicenter prospective studies are necessary to gain more insight into the added value of (broad) empirical antibiotic therapy.

Keywords: antibiotic resistance; fracture; fracture-related infection; infection; microbiology.

Publication types

Multicenter Study

MeSH terms

Anti-Bacterial Agents / therapeutic use
Coinfection* / drug therapy
Gram-Negative Bacteria
Humans
Microbial Sensitivity Tests
Prospective Studies
Retrospective Studies
Staphylococcus epidermidis

Substances

Anti-Bacterial Agents