Remission rate of implant-related infections following revision surgery after fractures.
OBJECTIVE
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.
Orthopaedic Surgery Service, Geneva University Hospitals & Medical School, University of Geneva, Geneva, Switzerland.
Mohamed
M
Al-Mayahi
Michael
M
Betz
Daniel A
DA
Müller
Richard
R
Stern
Phedon
P
Tahintzi
Louis
L
Bernard
Pierre
P
Hoffmeyer
Domizio
D
Suvà
Ilker
I
Uçkay
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology*; D001858:Bone Nails / Q000009:adverse effects / Q000382:microbiology; D001860:Bone Plates / Q000009:adverse effects / Q000382:microbiology; D001863:Bone Screws / Q000009:adverse effects / Q000382:microbiology; D001864:Bone Wires / Q000009:adverse effects / Q000382:microbiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D015994:Incidence; D016268:Internal Fixators / Q000009:adverse effects / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents