What is the diagnostic value of the Centers for Disease Control and Prevention criteria for surgical site infection in fracture-related infection?

• Published in: Injury 2021-10, Vol.52 (10), p.2879-2885
• Main Authors: Sliepen, Jonathan, Onsea, Jolien, Zalavras, Charalampos G., Depypere, Melissa, Govaert, Geertje A.M., Morgenstern, Mario, McNally, Martin A., Verhofstad, Michael H.J., Obremskey, William T., IJpma, Frank F.A., Metsemakers, Willem-Jan
• Format: Article
• Language: English
• Subjects: Center for disease control and prevention; Diagnosis; Diagnostic criteria; Fracture; Fracture-related infection; Infection
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2021.08.009

•This study confirms the importance of standardization with respect to the diagnosis of FRI.•The results endorse the diagnostic criteria of the FRI consensus definition.•When applying the consensus criteria, 98.9% of the infections that occured after operative fracture treatment could be adequately diagnosed.•The CDC criteria for organ/space SSI seem to have less diagnostic value in diagnosing FRI patients.•The main reasons that the CDC criteria have less diagnostic value are the limited follow up time and the restriction to long bones. Fracture-related infection (FRI) remains one of the most challenging complications in orthopaedic trauma surgery. An early diagnosis is of paramount importance to guide treatment. The primary aim of this study was to compare the Centers for Disease Control and Prevention (CDC) criteria for the diagnosis of organ/space surgical site infection (SSI) to the recently developed diagnostic criteria of the FRI consensus definition in operatively treated fracture patients. This international multicenter retrospective cohort study evaluated 257 patients with 261 infections after operative fracture treatment. All patients included in this study were considered to have an FRI and treated accordingly (‘intention to treat’). The minimum follow-up was one year. Infections were scored according to the CDC criteria for organ/space SSI and the diagnostic criteria of the FRI consensus definition. Overall, 130 (49.8%) FRIs were captured when applying the CDC criteria for organ/space SSI, whereas 258 (98.9%) FRIs were captured when applying the FRI consensus criteria. Patients could not be classified as having an infection according to the CDC criteria mainly due to a lack of symptoms within 90 days after the surgical procedure (n = 96; 36.8%) and due to the fact that the surgery was performed at an anatomical localization not listed in the National Healthcare Safety Network (NHSN) operative procedure code mapping (n = 37; 14.2%). This study confirms the importance of standardization with respect to the diagnosis of FRI. The results endorse the recently developed FRI consensus definition. When applying these diagnostic criteria, 98.9% of the infections that occured after operative fracture treatment could be captured. The CDC criteria for organ/space SSI captured less than half of the patients with an FRI requiring treatment, and seemed to have less diagnostic value in this patient population.