Elizabeth M Benson, Robert W Rutz, Austin C Atkins, Karen J Carter, Evan G Gross, Matthew Yeager, Joseph P Johnson, Clay A Spitler
{"title":"革兰氏阴性骨折相关感染的危险因素和感染表现。","authors":"Elizabeth M Benson, Robert W Rutz, Austin C Atkins, Karen J Carter, Evan G Gross, Matthew Yeager, Joseph P Johnson, Clay A Spitler","doi":"10.1097/BOT.0000000000002981","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To assess factors associated with gram-negative (GN) fracture related infections (FRIs) and the impact of GN infections in treatment and outcomes in FRIs.</p><p><strong>Methods: </strong>Design: Retrospective cohort.</p><p><strong>Setting: </strong>Single Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>All patients with extremity FRIs between 2013-2020.</p><p><strong>Outcome measures and comparisons: </strong>A univariate analysis of FRI bacteriology was conducted in two manners. Two group analysis compared Any GN (AGN) to Gram-positive (GP) only (GPO) FRIs . Three group analysis compared Gram-negative only (GNO) vs. GPO vs. Polymicrobial GN including GP (PGN) FRIs.</p><p><strong>Results: </strong>299 patients met inclusion criteria. The mean age was 45.59 (18-92), and 187 (62.5%) were male. 76 (25%) patients had a GN microbe on intraoperative culture. In the AGN vs. GPO comparison, there were more male GN FRI patients (AGN=74% vs. GPO=59%, p=0.02). Cardiovascular disease was less common in AGN FRI patients (AGN=17% vs. GPO=30%, p=0.028). Multisystem trauma (AGN=67% vs. GPO=50%, p=0.014), external fixation (AGN=50%, vs. GPO=33%, p=0.014), skin grafting (AGN=27% vs. GPO=15%, p=0.045) and flap coverage (AGN=32% vs. GPO=16%, p=0.011) were more common in the AGN FRI. AGN FRI patients had more sinus tracts on presentation (AGN=42% vs. GPO=27%, p=0.013) and higher rates of amputation (AGN=15% vs. GPO=6%, p=0.021. Nonunion rates did not differ between the groups (AGN=20% vs. GPO=22%, p=0.731). Total number of reoperations needed for infection clearance was similar between AGN (3.5 +/-2.7) and GPO (2.9 +/-2.5) FRIs (p=0.068). The 3-group comparison was performed between the following groups (GNO, GPO, PGN). Post-hoc analysis of the 3-group analysis demonstrated PGN infections had no significant differences from GNO FRI in regard to injury characteristics (lower extremity, polytrauma), surgical characteristics (external fixation, flap coverage) and sinus tract formation.</p><p><strong>Conclusion: </strong>Male sex, multi-system trauma, external fixation, and need for flap coverage or skin graft were associated with gram negative FRIs. Nonunion rates were similar between Gram-negative vs. Gram-positive only or Gram-negative vs. polymicrobial including Gram-negative FRIs. In comparison to patients with Gram-positive only FRI, any Gram-negative FRI led to a higher rate of amputation.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Risk Factors and Infection Presentation of Gram-Negative Fracture Related Infections.\",\"authors\":\"Elizabeth M Benson, Robert W Rutz, Austin C Atkins, Karen J Carter, Evan G Gross, Matthew Yeager, Joseph P Johnson, Clay A Spitler\",\"doi\":\"10.1097/BOT.0000000000002981\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To assess factors associated with gram-negative (GN) fracture related infections (FRIs) and the impact of GN infections in treatment and outcomes in FRIs.</p><p><strong>Methods: </strong>Design: Retrospective cohort.</p><p><strong>Setting: </strong>Single Level I Trauma Center.</p><p><strong>Patient selection criteria: </strong>All patients with extremity FRIs between 2013-2020.</p><p><strong>Outcome measures and comparisons: </strong>A univariate analysis of FRI bacteriology was conducted in two manners. Two group analysis compared Any GN (AGN) to Gram-positive (GP) only (GPO) FRIs . Three group analysis compared Gram-negative only (GNO) vs. GPO vs. Polymicrobial GN including GP (PGN) FRIs.</p><p><strong>Results: </strong>299 patients met inclusion criteria. The mean age was 45.59 (18-92), and 187 (62.5%) were male. 76 (25%) patients had a GN microbe on intraoperative culture. In the AGN vs. GPO comparison, there were more male GN FRI patients (AGN=74% vs. GPO=59%, p=0.02). Cardiovascular disease was less common in AGN FRI patients (AGN=17% vs. GPO=30%, p=0.028). Multisystem trauma (AGN=67% vs. GPO=50%, p=0.014), external fixation (AGN=50%, vs. GPO=33%, p=0.014), skin grafting (AGN=27% vs. GPO=15%, p=0.045) and flap coverage (AGN=32% vs. GPO=16%, p=0.011) were more common in the AGN FRI. AGN FRI patients had more sinus tracts on presentation (AGN=42% vs. GPO=27%, p=0.013) and higher rates of amputation (AGN=15% vs. GPO=6%, p=0.021. Nonunion rates did not differ between the groups (AGN=20% vs. GPO=22%, p=0.731). Total number of reoperations needed for infection clearance was similar between AGN (3.5 +/-2.7) and GPO (2.9 +/-2.5) FRIs (p=0.068). The 3-group comparison was performed between the following groups (GNO, GPO, PGN). Post-hoc analysis of the 3-group analysis demonstrated PGN infections had no significant differences from GNO FRI in regard to injury characteristics (lower extremity, polytrauma), surgical characteristics (external fixation, flap coverage) and sinus tract formation.</p><p><strong>Conclusion: </strong>Male sex, multi-system trauma, external fixation, and need for flap coverage or skin graft were associated with gram negative FRIs. Nonunion rates were similar between Gram-negative vs. Gram-positive only or Gram-negative vs. polymicrobial including Gram-negative FRIs. In comparison to patients with Gram-positive only FRI, any Gram-negative FRI led to a higher rate of amputation.</p><p><strong>Level of evidence: </strong>III.</p>\",\"PeriodicalId\":16644,\"journal\":{\"name\":\"Journal of Orthopaedic Trauma\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-04-07\",\"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.0000000000002981\",\"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.0000000000002981","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
目的：评估与革兰氏阴性（GN）骨折相关感染（FRIs）相关的因素以及GN感染对FRIs治疗和预后的影响。方法：设计：回顾性队列。地点：一级创伤中心。患者选择标准：2013-2020年间所有肢体fri患者。结果测量和比较：采用两种方法对FRI细菌学进行单变量分析。两组分析比较了任何GN （AGN）和革兰氏阳性（GP） （GPO） fri。三组分析比较了革兰氏阴性（GNO）、GPO和包括GP (PGN) fri的多微生物GN。结果：299例患者符合纳入标准。平均年龄45.59岁（18-92岁），男性187例（62.5%）。76例（25%）患者术中培养有GN微生物。在AGN与GPO的比较中，男性GN FRI患者较多（AGN=74% vs. GPO=59%, p=0.02）。AGN FRI患者中心血管疾病较少（AGN=17% vs. GPO=30%, p=0.028）。多系统创伤（AGN=67% vs. GPO=50%, p=0.014）、外固定（AGN=50% vs. GPO=33%, p=0.014）、植皮（AGN=27% vs. GPO=15%, p=0.045）和皮瓣覆盖（AGN=32% vs. GPO=16%, p=0.011）在AGN FRI中更为常见。AGN FRI患者在出现时有更多的窦道（AGN=42% vs. GPO=27%, p=0.013）和更高的截肢率（AGN=15% vs. GPO=6%, p=0.021）。两组间骨不连率无差异（AGN=20% vs. GPO=22%, p=0.731）。AGN（3.5 +/-2.7）和GPO (2.9 +/-2.5) fri的再手术次数相似（p=0.068）。GNO、GPO、PGN组之间进行3组比较。三组分析的事后分析显示，PGN感染在损伤特征（下肢、多发伤）、手术特征（外固定、皮瓣覆盖）和窦道形成方面与GNO FRI无显著差异。结论：男性、多系统创伤、外固定、皮瓣覆盖或皮肤移植与革兰氏阴性FRIs相关。革兰氏阴性与仅革兰氏阳性或革兰氏阴性与包括革兰氏阴性FRIs在内的多种微生物不愈合率相似。与仅革兰氏阳性FRI患者相比，任何革兰氏阴性FRI导致更高的截肢率。证据水平：III。
Risk Factors and Infection Presentation of Gram-Negative Fracture Related Infections.
Objective: To assess factors associated with gram-negative (GN) fracture related infections (FRIs) and the impact of GN infections in treatment and outcomes in FRIs.
Methods: Design: Retrospective cohort.
Setting: Single Level I Trauma Center.
Patient selection criteria: All patients with extremity FRIs between 2013-2020.
Outcome measures and comparisons: A univariate analysis of FRI bacteriology was conducted in two manners. Two group analysis compared Any GN (AGN) to Gram-positive (GP) only (GPO) FRIs . Three group analysis compared Gram-negative only (GNO) vs. GPO vs. Polymicrobial GN including GP (PGN) FRIs.
Results: 299 patients met inclusion criteria. The mean age was 45.59 (18-92), and 187 (62.5%) were male. 76 (25%) patients had a GN microbe on intraoperative culture. In the AGN vs. GPO comparison, there were more male GN FRI patients (AGN=74% vs. GPO=59%, p=0.02). Cardiovascular disease was less common in AGN FRI patients (AGN=17% vs. GPO=30%, p=0.028). Multisystem trauma (AGN=67% vs. GPO=50%, p=0.014), external fixation (AGN=50%, vs. GPO=33%, p=0.014), skin grafting (AGN=27% vs. GPO=15%, p=0.045) and flap coverage (AGN=32% vs. GPO=16%, p=0.011) were more common in the AGN FRI. AGN FRI patients had more sinus tracts on presentation (AGN=42% vs. GPO=27%, p=0.013) and higher rates of amputation (AGN=15% vs. GPO=6%, p=0.021. Nonunion rates did not differ between the groups (AGN=20% vs. GPO=22%, p=0.731). Total number of reoperations needed for infection clearance was similar between AGN (3.5 +/-2.7) and GPO (2.9 +/-2.5) FRIs (p=0.068). The 3-group comparison was performed between the following groups (GNO, GPO, PGN). Post-hoc analysis of the 3-group analysis demonstrated PGN infections had no significant differences from GNO FRI in regard to injury characteristics (lower extremity, polytrauma), surgical characteristics (external fixation, flap coverage) and sinus tract formation.
Conclusion: Male sex, multi-system trauma, external fixation, and need for flap coverage or skin graft were associated with gram negative FRIs. Nonunion rates were similar between Gram-negative vs. Gram-positive only or Gram-negative vs. polymicrobial including Gram-negative FRIs. In comparison to patients with Gram-positive only FRI, any Gram-negative FRI led to a higher rate of amputation.
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.
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