Microbiome of infected fracture nonunion: Does it affect outcomes?

IF 1.5 4区 医学 Q3 ORTHOPEDICS Journal of Orthopaedic Science Pub Date : 2024-09-01 DOI:10.1016/j.jos.2023.08.018
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引用次数: 0

Abstract

Background

Infected fracture nonunions often require prolonged treatment and recovery courses. It is unclear whether the bacterial microbiome influences the time to healing as well as the eradication of infection. The goals of this study are (1) to assess the bacterial microbiome affecting infected nonunions and (2) to evaluate the effects of bacterial speciation on associated outcomes.

Methods

Between 2006 and 2022, data from 551 adult patients from a single academic institution who presented with a fracture nonunion were analyzed retrospectively for infection. All patients underwent revision surgery with three sets of cultures obtained intra-operatively. Patients with significant intra-operative cultures were grouped into gram-positive and gram-negative culture cohorts. These patients were managed with a standardized protocol involving surgical debridement, nonunion site fixation, and culture-directed antibiotic treatment. Primary outcome was time to fracture union. Secondary outcomes included number of re-operations and eventual amputation or reconstructive surgery.

Results

56 nonunion patients (10 %) were diagnosed with an infected nonunion (44 g-positive, 12 g-negative). Of these, 3 g-positive patients received an amputation or arthroplasty procedure prior to fracture union, and seven were lost to follow-up. There were no significant differences in age, gender, or nonunion site between cohorts. Most nonunions occurred in the lower extremity. The most common bacteria were staph species (54.3 %). 36 g-positive and 10 g-negative patients achieved fracture union. Time to union was on average 158.4 days longer in the gram-negative cohort—but did not reach statistical significance (446.8 days gram-positive, 662.3 days gram-negative, p = 0.69). There was no difference in re-operation rates (1.9 % gram-positive, 2.2 % gram-negative, p = 0.84).

Conclusions

Patients with infected nonunions had wide-ranging bacterial contamination that were treated successfully using a standardized protocol. However, patients with any gram-negative culture trended toward a delay in time to union.

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感染性骨折不愈合的微生物组:是否影响疗效?
背景:感染性骨折不愈合通常需要延长治疗和恢复时间。目前尚不清楚细菌微生物组是否会影响愈合时间以及感染的根除。这项研究的目标是(1)评估影响感染非尼翁的细菌微生物组,以及(2)评估细菌物种形成对相关结果的影响。方法:回顾性分析2006年至2022年间,来自一家学术机构的551名出现骨折不愈合的成年患者的感染数据。所有患者均接受了翻修手术,术中获得了三组培养物。术中培养显著的患者被分为革兰氏阳性和革兰氏阴性培养组。这些患者采用标准化方案进行治疗,包括手术清创、骨不连部位固定和培养导向的抗生素治疗。主要结果是骨折愈合时间。次要结果包括多次再次手术和最终的截肢或重建手术。结果:56例骨不连患者(10%)被诊断为感染性骨不连(44g阳性,12g阴性)。其中,3例g阳性患者在骨折愈合前接受了截肢或关节成形术,7例失访。队列之间在年龄、性别或骨不连部位方面没有显著差异。大多数骨不连发生在下肢。最常见的细菌是葡萄球菌(54.3%)。36例g阳性和10例g阴性患者实现了骨折愈合。在革兰氏阴性队列中,愈合时间平均延长158.4天,但没有达到统计学意义(446.8天革兰氏阳性,662.3天革兰氏阴性,p=0.69)。再次手术率没有差异(1.9%革兰氏阳性,2.2%革兰氏阴性,p=0.84)成功地使用了标准化协议。然而,任何革兰氏阴性培养的患者都倾向于延迟愈合时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Orthopaedic Science
Journal of Orthopaedic Science 医学-整形外科
CiteScore
3.00
自引率
0.00%
发文量
290
审稿时长
90 days
期刊介绍: The Journal of Orthopaedic Science is the official peer-reviewed journal of the Japanese Orthopaedic Association. The journal publishes the latest researches and topical debates in all fields of clinical and experimental orthopaedics, including musculoskeletal medicine, sports medicine, locomotive syndrome, trauma, paediatrics, oncology and biomaterials, as well as basic researches.
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