Implant-associated infection after hip fracture surgery in elderly patients: Risk factors and mortality

• Published in: Injury 2024-10, Vol.55, p.111756, Article 111756
• Main Authors: Ojeda-Thies, Cristina, Rojo-Carpintero, Ana, Soria-Perdomo, Francisco, Ramos-Pascua, Luis Rafael
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antibiofilm antibiotics; Arthroplasty, Replacement, Hip - adverse effects; Biofilms; Comorbidity; Dair; Elderly; Female; Hip fracture; Hip Fractures - mortality; Hip Fractures - surgery; Humans; Implant-related infection; Male; One-year mortality; Prognosis; Prosthesis-Related Infections - microbiology; Prosthesis-Related Infections - mortality; Prosthesis-Related Infections - surgery; Retrospective Studies; Risk Factors; Treatment failure
• ISSN: 0020-1383; 1879-0267; 1879-0267
• DOI: 10.1016/j.injury.2024.111756

•Infection after hip fracture surgery carries an elevated risk of mortality and treatment failure.•Antibiofilm strategies were main predictors of treatment success: simple lavage and not using rifampin/quinolones reduced chances of success.•The success rate after DAIR with exchange of mobile components for arthroplasties was higher than previously reported.•Nearly half of treatment failures in acute infections can be attributed to insufficient operative control of the infection. Our study aimed to evaluate the prognosis of implant-related infection following hip fracture and pre-surgical, surgical and microbiological factors modifying outcomes. We retrospectively included patients aged 65 and older treated for infection following surgically managed hip fractures between 2012 and 2022. Periprosthetic and high-energy fractures were excluded. Data was obtained by clinical chart review, including: age, gender, Barthel index, Charlson Score, National Hip Fracture Database (NHFD) Mobility Score, surgery and infection type, causative pathogens, antimicrobial resistance, anti-biofilm antibiotic treatment and clinical situation at one-year follow up. The outcomes evaluated were failure/resolution of infection and one-year mortality. We included 80 patients (67 women, 83.8 %) aged a median of 85 years (interquartile range: 78 – 88 years). Treatment failed in 38 (47.5 %) patients, and the one-year mortality was 37.5 %. Patients dying within 12 months after treatment were more likely to suffer acute vs. chronic infections (OR = 3.29 [95 %CI: 1.20–9.04]), be older and have more comorbidity, but baseline function and ambulation were not predictive. Treatment failure was higher among patients receiving non-antibiofilm controlling surgery, specifically surgical lavage (OR = 3.79 [95 %CI: 1.38–10,37]), as well as in older, more dependent patients. Receiving anti-biofilm antibiotics for more than 2 weeks was associated with less treatment failure (OR:0.32; [95 %CI: 0.13–0.80]) and 12-month mortality (OR:0.22 [95 %CI: 0.08–0.60]). Antibiofilm-controlling surgery and antibiotics improve treatment success following implant-related infection after hip fracture and should be considered regardless of fracture type. Acute infections are a “second hit” for frail patients recovering from initial surgery and are associated with increased mortality.