Remission rate of implant-related infections following revision surgery after fractures

• Published in: International orthopaedics 2013-11, Vol.37 (11), p.2253-2258
• Main Authors: Al-Mayahi, Mohamed, Betz, Michael, Müller, Daniel A., Stern, Richard, Tahintzi, Phedon, Bernard, Louis, Hoffmeyer, Pierre, Suvà, Domizio, Uçkay, Ilker
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anti-Bacterial Agents - therapeutic use; Bacterial Infections - drug therapy; Bacterial Infections - epidemiology; Bone Nails - adverse effects; Bone Nails - microbiology; Bone Plates - adverse effects; Bone Plates - microbiology; Bone Screws - adverse effects; Bone Screws - microbiology; Bone Wires - adverse effects; Bone Wires - microbiology; Cohort Studies; Female; Follow-Up Studies; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Fractures, Bone - surgery; Humans; Incidence; Internal Fixators - adverse effects; Internal Fixators - microbiology; Male; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Orthopedics; Remission Induction; Reoperation; Retrospective Studies; Surgical Wound Infection - epidemiology; Surgical Wound Infection - microbiology; Surgical Wound Infection - therapy; Treatment Outcome
• ISSN: 0341-2695; 1432-5195
• DOI: 10.1007/s00264-013-2092-1

Purpose In contrast to a large amount of epidemiological data regarding the incidence of implant infections after fracture management, surprisingly few have been published concerning the success of their treatment. Methods This was a single-centre cohort study at Geneva University Hospitals from 2000 to 2012 investigating the remission rates of orthopaedic implant infections after fracture repair and associated variables. Results A total of 139 episodes were included: There were 51 women (37 %) and 28 immunosuppressed (20 %) patients with a median age and American Society of Anaesthesiologists (ASA) score of 51 years and 2 points, respectively. The infected implants were plates ( n  = 75, 54 %), nails (24, 17 %), wires (20), screws (10), cerclage cables or wires (3), hip screws (4) or material for spondylodesis (3). A pathogen was identified in 135 (97 %) cases, including Staphylococcus aureus (73, 52 %), coagulase-negative staphylococci (20), streptococci (7) and 19 Gram-negative rods. All patients underwent antibiotic treatment, and 128 (92 %) remained in remission at a median follow-up time of 2.6 years (range one to 13 years). In multivariate logistic regression analysis, the plate infections were significantly associated with lower remission rates [65/75, 87 %, odds ratio (OR) 0.1, 95 % confidence interval (CI) 0.01–0.90]. No associations were found for gender, age, immune status, ASA score, additional surgical interventions (OR 0.4, 95 % CI 0.1–4.1) or duration of antibiotic treatment (OR 1.0, 95 % CI 0.98–1.01). Conclusions Among all infected and removed orthopaedic implants, plates were associated with slightly lower remission rates, while the overall treatment success exceeded 90 %. The duration of antibiotic therapy did not alter the outcome.