Epidemiology and Drug Resistance of Fracture-Related Infection of the Long Bones of the Extremities: A Retrospective Study at the Largest Trauma Center in Southwest China

Zhengdong Zhang; Pan Liu; Wenzhao Wang; Shanxi Wang; Bohua Li; Jun Li; Banyin Yang; Mingxin Li; Qin Li; Hai Yang; Zeyu Huang; Lei Liu

doi:10.3389/fmicb.2022.923735

Epidemiology and Drug Resistance of Fracture-Related Infection of the Long Bones of the Extremities: A Retrospective Study at the Largest Trauma Center in Southwest China

Front Microbiol. 2022 Jul 12:13:923735. doi: 10.3389/fmicb.2022.923735. eCollection 2022.

Authors

Zhengdong Zhang^{1

2}, Pan Liu³, Wenzhao Wang⁴, Shanxi Wang⁵, Bohua Li⁴, Jun Li⁴, Banyin Yang⁴, Mingxin Li⁴, Qin Li⁴, Hai Yang⁴, Zeyu Huang⁴, Lei Liu⁴

Affiliations

¹ School of Clinical Medicine, Chengdu Medical College, Chengdu, China.
² Department of Orthopedics, The First Affiliated Hospital of Chengdu Medical College, Chengdu Medical College, Chengdu, China.
³ School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
⁴ Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China.
⁵ Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Abstract

Objective: To describe the demographic characteristics, risk factors, and bacterial resistance of fracture-related infection (FRI) of the long bones of the extremities.

Materials and methods: This single-center study retrospectively evaluated patients with FRI of the long bones of the extremities at West China Hospital between January 2012 and December 2017, and analyzed the demographic characteristics, risk factors, distribution of pathogenic bacteria, and bacterial drug resistance.

Results: Among 9,900 patients, 535 patients (5.4%) were diagnosed with FRI. The most common site of FRI was tibiofibular (298, 55.7%), with 424 cases (79.2%) of open fractures, and 282 cases (52.7%) due to traffic injuries. The 41-50 years age group had the highest incidence of FRI with 157 (29.3%) cases. Overall, 546 strains of 52 types of bacteria were detected in FRI patients, with 105 strains of multidrug-resistant (MDR) bacteria. Methicillin-resistant Staphylococcus aureus (48, 8.8%) and extended-spectrum-β-lactamase Escherichia coli (32, 5.8%) accounted for the largest proportion. Multivariate logistic regression analysis showed that sex (odds ratio [OR] 1.813; 95% confidence interval [CI], 1.071∼3.070; P = 0.027) and fracture type (OR 3.128; 95% CI, 1.683∼5.815; P < 0.001) were independent risk factors for monomicrobial infection (MI). Female sex (OR 4.190; 95% CI, 1.212∼14.486; P = 0.024) was an independent risk factor for polymicrobial infection (PI).

Conclusion: This study clarified the infection rates, changes in the bacterial spectrum, and drug resistance characteristics, and risk factors of FRI of the long bones of the extremities in the largest trauma center in southwest China.

Keywords: drug resistance; epidemiology; extremities; fracture-related infection; long bone fracture; risk factors.