Remission rate of implant-related infections following revision surgery after fractures
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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.
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.
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).
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.
KeywordsImplant-related infection Implant removal Antibiotic therapy Remission rate Post-traumatic osteomyelitis
We thank the teams of the Orthopaedic Department and the Laboratory of Microbiology for their support.
Conflict of interest
The authors declare that they have no conflict of interest.