Does the Use of Local Antibiotics Affect Clinical Outcome of Patients with Fracture-Related Infection?

This international, multi-center study evaluated the effect of antibiotic-loaded carriers (ALCs) on outcome in patients with a fracture-related infection (FRI) and evaluated whether bacterial resistance to the implanted antibiotics influences their efficacy. All patients who were retrospectively dia...

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Bibliographic Details
Published in:Antibiotics (Basel) 2022-09, Vol.11 (10), p.1330
Main Authors: Sliepen, Jonathan, Corrigan, Ruth A, Dudareva, Maria, Wouthuyzen-Bakker, Marjan, Rentenaar, Rob J, Atkins, Bridget L, Govaert, Geertje A M, McNally, Martin A, IJpma, Frank F A
Format: Article
Language:English
Subjects:
antibiotic-loaded carriers
Antibiotics
Antimicrobial agents
Bacteria
Biofilms
Care and treatment
Clinical outcomes
Drug resistance in microorganisms
Evaluation
fracture
fracture-related infection
Fractures
Gentamicin
Health risks
Infection
Infections
local antibiotics
Microorganisms
Pathogens
Patient outcomes
Patients
Regression analysis
Statistical analysis
Statistical significance
Surgery
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Summary:This international, multi-center study evaluated the effect of antibiotic-loaded carriers (ALCs) on outcome in patients with a fracture-related infection (FRI) and evaluated whether bacterial resistance to the implanted antibiotics influences their efficacy. All patients who were retrospectively diagnosed with FRI according to the FRI consensus definition, between January 2015 and December 2019, and who underwent surgical treatment for FRI at any time point after injury, were considered for inclusion. Patients were followed-up for at least 12 months. The primary outcome was the recurrence rate of FRI at follow-up. Inverse probability for treatment weighting (IPTW) modeling and multivariable regression analyses were used to assess the relationship between the application of ALCs and recurrence rate of FRI at 12 months and 24 months. Overall, 429 patients with 433 FRIs were included. A total of 251 (58.0%) cases were treated with ALCs. Gentamicin was the most frequently used antibiotic (247/251). Recurrence of infection after surgery occurred in 25/251 (10%) patients who received ALCs and in 34/182 (18.7%) patients who did not (unadjusted hazard ratio (uHR): 0.48, 95% CI: [0.29-0.81]). Resistance of cultured microorganisms to the implanted antibiotic was not associated with a higher risk of recurrence of FRI (uHR: 0.75, 95% CI: [0.32-1.74]). The application of ALCs in treatment of FRI is likely to reduce the risk of recurrence of infection. The high antibiotic concentrations of ALCs eradicate most pathogens regardless of susceptibility test results.
ISSN:2079-6382
2079-6382
DOI:10.3390/antibiotics11101330