Robert Kaspar Wagner, M. P. Emmelot, C. van Trikt, Caroline E. Visser, Edgar J. G. Peters, Stein J. Janssen, Peter Kloen
{"title":"假定无菌性无脓肿隐匿性感染的特征和结果:回顾性队列研究","authors":"Robert Kaspar Wagner, M. P. Emmelot, C. van Trikt, Caroline E. Visser, Edgar J. G. Peters, Stein J. Janssen, Peter Kloen","doi":"10.1097/bot.0000000000002822","DOIUrl":null,"url":null,"abstract":"\n \n To determine (1) the rate of positive cultures in presumed aseptic nonunions, (2) the rate and microbial spectrum of positive cultures that represented occult infection, and (3) rates of nonunion healing.\n \n \n \n Retrospective cohort study.\n \n \n \n Tertiary referral center.\n \n \n \n Adult patients with a presumed aseptic nonunion treated with single-stage revision between 2002 and 2022.\n \n \n \n The rate of positive cultures compared for two protocols: old: 1 – 2 samples cultured 7 days vs. new: 5 samples cultured 14 days. The rate of positive cultures meeting occult infection criteria with the new protocol (≥ 2 samples with phenotypically indistinguishable microorganisms, or ≥1 sample with a high virulent microorganism). Nonunion healing rates between protocols and between groups based on culture results with the new protocol.\n \n \n \n 179 patients were included. The rate of positive cultures was 14% (n = 15/105) with the old protocol, and 51% (n = 38/74) with the new protocol (p < 0.001). With the new protocol, the rate of positive cultures meeting occult infection criteria was 19% (n = 14/74), and Coagulase-negative staphylococci (48%) and Cutibacterium acnes (38%) were the most common microorganisms. Nonunion healing rates after the primary revision did not differ between protocols (old: 82% vs. new: 86%, p = 0.41) and groups based on culture result (sterile: 86% vs. occultly infected: 93%, p = 0.66). The final overall nonunion healing rate was 97%.\n \n \n \n Occult infections were identified in 1 in 5 presumed aseptic nonunions using a standardized protocol with 5 intraoperative samples cultured 14 days, and were predominantly caused by slow growing, gram-positive microorganisms. The local spectrum and antimicrobial sensitivity of occult infections should be considered when developing empiric antimicrobial protocols. Patients with presumed aseptic nonunions can expect high healing rates regardless of the culture result.\n \n \n \n Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.\n","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":null,"pages":null},"PeriodicalIF":1.6000,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Characteristics and Outcomes of Occult Infections in Presumed Aseptic Nonunions: A Retrospective Cohort Study\",\"authors\":\"Robert Kaspar Wagner, M. P. Emmelot, C. van Trikt, Caroline E. Visser, Edgar J. G. Peters, Stein J. Janssen, Peter Kloen\",\"doi\":\"10.1097/bot.0000000000002822\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"\\n \\n To determine (1) the rate of positive cultures in presumed aseptic nonunions, (2) the rate and microbial spectrum of positive cultures that represented occult infection, and (3) rates of nonunion healing.\\n \\n \\n \\n Retrospective cohort study.\\n \\n \\n \\n Tertiary referral center.\\n \\n \\n \\n Adult patients with a presumed aseptic nonunion treated with single-stage revision between 2002 and 2022.\\n \\n \\n \\n The rate of positive cultures compared for two protocols: old: 1 – 2 samples cultured 7 days vs. new: 5 samples cultured 14 days. The rate of positive cultures meeting occult infection criteria with the new protocol (≥ 2 samples with phenotypically indistinguishable microorganisms, or ≥1 sample with a high virulent microorganism). Nonunion healing rates between protocols and between groups based on culture results with the new protocol.\\n \\n \\n \\n 179 patients were included. The rate of positive cultures was 14% (n = 15/105) with the old protocol, and 51% (n = 38/74) with the new protocol (p < 0.001). With the new protocol, the rate of positive cultures meeting occult infection criteria was 19% (n = 14/74), and Coagulase-negative staphylococci (48%) and Cutibacterium acnes (38%) were the most common microorganisms. Nonunion healing rates after the primary revision did not differ between protocols (old: 82% vs. new: 86%, p = 0.41) and groups based on culture result (sterile: 86% vs. occultly infected: 93%, p = 0.66). The final overall nonunion healing rate was 97%.\\n \\n \\n \\n Occult infections were identified in 1 in 5 presumed aseptic nonunions using a standardized protocol with 5 intraoperative samples cultured 14 days, and were predominantly caused by slow growing, gram-positive microorganisms. The local spectrum and antimicrobial sensitivity of occult infections should be considered when developing empiric antimicrobial protocols. Patients with presumed aseptic nonunions can expect high healing rates regardless of the culture result.\\n \\n \\n \\n Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.\\n\",\"PeriodicalId\":16644,\"journal\":{\"name\":\"Journal of Orthopaedic Trauma\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-04-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Orthopaedic Trauma\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/bot.0000000000002822\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Trauma","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/bot.0000000000002822","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Characteristics and Outcomes of Occult Infections in Presumed Aseptic Nonunions: A Retrospective Cohort Study
To determine (1) the rate of positive cultures in presumed aseptic nonunions, (2) the rate and microbial spectrum of positive cultures that represented occult infection, and (3) rates of nonunion healing.
Retrospective cohort study.
Tertiary referral center.
Adult patients with a presumed aseptic nonunion treated with single-stage revision between 2002 and 2022.
The rate of positive cultures compared for two protocols: old: 1 – 2 samples cultured 7 days vs. new: 5 samples cultured 14 days. The rate of positive cultures meeting occult infection criteria with the new protocol (≥ 2 samples with phenotypically indistinguishable microorganisms, or ≥1 sample with a high virulent microorganism). Nonunion healing rates between protocols and between groups based on culture results with the new protocol.
179 patients were included. The rate of positive cultures was 14% (n = 15/105) with the old protocol, and 51% (n = 38/74) with the new protocol (p < 0.001). With the new protocol, the rate of positive cultures meeting occult infection criteria was 19% (n = 14/74), and Coagulase-negative staphylococci (48%) and Cutibacterium acnes (38%) were the most common microorganisms. Nonunion healing rates after the primary revision did not differ between protocols (old: 82% vs. new: 86%, p = 0.41) and groups based on culture result (sterile: 86% vs. occultly infected: 93%, p = 0.66). The final overall nonunion healing rate was 97%.
Occult infections were identified in 1 in 5 presumed aseptic nonunions using a standardized protocol with 5 intraoperative samples cultured 14 days, and were predominantly caused by slow growing, gram-positive microorganisms. The local spectrum and antimicrobial sensitivity of occult infections should be considered when developing empiric antimicrobial protocols. Patients with presumed aseptic nonunions can expect high healing rates regardless of the culture result.
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
期刊介绍:
Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.