Outcome and risk factors for recurrence of early onset fracture-related infections treated with debridement, antibiotics and implant retention: Results of a large retrospective multicentre cohort study

• Published in: Injury Vol. 53; no. 12; pp. 3930 - 3937
• Main Authors: Buijs, M.A.S., van den Kieboom, J., Sliepen, J., Wever, K.L.H., van Breugel, J.M., Hietbrink, F., IJpma, F.F.A., Govaert, G.A.M.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.12.2022
• Subjects: DAIR; Fracture; Fracture-related infection; Infection; Injury severity score; Outcome; Posttraumatic osteomyelitis; Trauma; Trauma surgery; Infection; Posttraumatic osteomyelitis; Outcome; Fracture-related infection; DAIR; Fracture; Injury severity score; Trauma surgery; Trauma
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2022.10.017

•Presence of an intramedullary nail is highly associated with recurrence of infection after a DAIR procedure for early onset FRI.•Other independent risk factors for FRI recurrence are the need for additional surgical procedures and a decreased ISS.•The recurrence rate in this cohort at one year follow-up is 13%. The overall recurrence rate within a median follow-up of 23.1 months is 18%.•Overall infection control in patients with early onset FRI was achieved in 94% of patients.•A total of 73 patients (52%) underwent at least two surgical procedures (debridement and/or washout) in order to treat the ongoing FRI. Early Fracture-Related Infections (FRIs) are a common entity in hospitals treating trauma patients and are often treated with a Debridement, Antibiotics and Implant Retention (DAIR) procedure. Aims of this study were to 1) evaluate the recurrence rate after DAIR procedures for early onset FRI, 2) establish the number of surgical procedures to gain control of the initial infection and 3) identify independent predictors for recurrence in this cohort. A retrospective multicentre cohort study was conducted in two level 1 trauma centres. Consecutive patients who underwent a DAIR procedure between January 1st 2015 and July 1st 2020 for confirmed FRI with an onset of <6 weeks after the latest osseous operation were included. Recorded data included patient demographics, treatment characteristics and follow-up. Univariate and multivariate logistic regression analyses were performed to assess predictors for recurrent FRI. A total of 141 patients with early FRI were included in this study with a median age of 54.0 years (interquartile range (IQR) 34.5–64.0). The recurrence rate of FRI was 13% (n = 19) at one year follow-up and 18% (n = 25) at 23.1 months (IQR 15.3–36.4) follow-up. Infection control was achieved in 94% (n = 127/135) of cases. In total, 73 patients (52%) underwent at least two surgical procedures to treat the ongoing initial episode of FRI, of whom 54 patients (74%) required two to three procedures and 17 patients (23%) four to five procedures. Predictors for recurrent FRI were use of an intramedullary nail during index operation (odds ratio (OR) 4.0 (95% confidence interval (CI) 1.1–13.8)), need for additional surgical procedures to treat ongoing infection during the treatment period following the first presentation of early FRI (OR 1.9 (95% CI 1.1–3.5)) and a decreased Injury Severity Score (ISS) (inverted OR 1.1 (95% CI 1.0–1.1)). The recurrence rate after treatment of early onset FRI in patients treated with a DAIR procedure was 18% at 23.1 months follow-up. At least two surgical procedures to gain control of the initial infection were needed in 52% of patients. Independent predictors for recurrent FRI were the use of an intramedullary nail during index operation, need for additional surgical procedures and a decreased ISS.