The impact of a multidisciplinary team on the management of fracture-related infections: A surveillance study in Brazil

Background

Fracture-Related Infection (FRI) is an increasing and challenging complication following orthopedic trauma surgery. Preventive and microbial diagnostic measures vary significantly particularly in low- and middle-income countries. The objectives of this national questionnaire were to investigate clinical practices towards preventive and diagnostic strategies adopted by Brazilian orthopedic trauma centers and to assess the impact of Multidisciplinary Teams (MDT) on the management of FRI.

Methods

A 34-item electronic questionnaire was developed via REDCap® and distributed to all trauma surgeons registered of the Brazilian Society of Orthopedics and Traumatology (SBOT).

Results

With a response rate of 24 %, the survey was fully responded by 140 trauma surgeons, 63.6 % of them working in southeast region centers. Collaborative work with MDT focused on musculoskeletal infections was reported by only 41.0 %. Cephalosporins were universally prescribed as Perioperative Antibiotic Prophylaxis (PAP), while association with an aminoglycoside increased (35.0 %) for severe open fracture. One-day duration of PAP for closed fracture was prescribed in 68.1 %, while it often exceeded current recommendations. Diagnostic practices for FRI patients were primarily based on clinical signs and standard radiological and laboratory tests, with limited use of microbiological techniques. Trauma services working collaboratively with MDT significantly improved FRI management, including, use of sonication fluid for diagnosis (46.6 % vs. 26.8 %; p = 0.02), body weight-adjusted antibiotic dosing for PAP (50.0 % vs. 24.4 %; p = 0.02), appropriate duration of PAP according to the severity of soft-tissue damage (80.7 % vs. 59.3 %; p = 0.01), infection risk stratification in elderly patients with fractures (45.6 % vs. 21.0 %; p < 0.001), use of negative-pressure wound therapy (87.9 % vs. 54.9 %; p < 0.001) and regular collaboration with orthoplastic surgeon (44.8 % vs. 17.5 %; p = 0.01).

Conclusions

This national survey revealed marked heterogeneity in FRI management across Brazilian trauma services. Ongoing MDT collaboration improved clinical practice, especially diagnostic work-up and antimicrobial stewardship.