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Walter N, Loew T, Hinterberger T, Alt V, Rupp M. Managing more than bones: the psychological impact of a recurrent fracture-related infection. Bone Jt Open 2024; 5:621-627. [PMID: 39084630 PMCID: PMC11290945 DOI: 10.1302/2633-1462.58.bjo-2023-0156.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024] Open
Abstract
Aims Fracture-related infections (FRIs) are a devastating complication of fracture management. However, the impact of FRIs on mental health remains understudied. The aim of this study was a longitudinal evaluation of patients' psychological state, and expectations for recovery comparing patients with recurrent FRI to those with primary FRI. Methods A prospective longitudinal study was conducted at a level 1 trauma centre from January 2020 to December 2022. In total, 56 patients treated for FRI were enrolled. The ICD-10 symptom rating (ISR) and an expectation questionnaire were assessed at five timepoints: preoperatively, one month postoperatively, and at three, six, and 12 months. Results Recurrent FRI cases consistently exceeded the symptom burden threshold (0.60) in ISR scores at all assessment points. The difference between preoperative-assessed total ISR scores and the 12-month follow-up was not significant in either group, with 0.04 for primary FRI (p = 0.807) and 0.01 for recurrent FRI (p = 0.768). While primary FRI patients showed decreased depression scores post surgery, recurrent FRI cases experienced an increase, reaching a peak at 12 months (1.92 vs 0.94; p < 0.001). Anxiety scores rose for both groups after surgery, notably higher in recurrent FRI cases (1.39 vs 1.02; p < 0.001). Moreover, patients with primary FRI reported lower expectations of returning to normal health at three (1.99 vs 1.11; p < 0.001) and 12 months (2.01 vs 1.33; p = 0.006). Conclusion The findings demonstrate the significant psychological burden experienced by individuals undergoing treatment for FRI, which is more severe in recurrent FRI. Understanding the psychological dimensions of recurrent FRIs is crucial for comprehensive patient care, and underscores the importance of integrating psychological support into the treatment paradigm for such cases.
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Affiliation(s)
- Nike Walter
- Department for Psychosomatic Medicine, University Hospital Regensburg, Regensburg, Germany
- Department for Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Loew
- Department for Psychosomatic Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Thilo Hinterberger
- Department for Psychosomatic Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Volker Alt
- Department for Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Markus Rupp
- Department for Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
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Eelsing R, Penning D, Vos-van der Meer M, Hodiamont CJ, Mathôt RAA, Schepers T. Plasma and tissue concentrations of 2 g prophylactic cefazolin prior to lower extremity surgery. Antimicrob Agents Chemother 2024; 68:e0049424. [PMID: 38771030 PMCID: PMC11232394 DOI: 10.1128/aac.00494-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 05/22/2024] Open
Abstract
Surgical site infections (SSIs) are among the most clinically relevant complications and the use of prophylactic cefazolin is common practice. However, the knowledge about the pharmacological aspects of prophylactic cefazolin in the lower extremities remains limited. In this prospective cohort, a sub-study of the WIFI-2 randomized controlled trial, adults between 18 and 75 years of age who were scheduled for implant removal below the level of the knee and randomized for cefazolin, was included. A maximum of two venous plasma, target-site plasma, and target-site tissue samples were taken during surgery. The primary outcomes were the cefazolin concentrations in venous plasma, target-site plasma, and target-site tissue. A total of 27 patients [median (interquartile range) age, 42 (29-59) years; 17 (63%) male] with 138 samples were included in the study. A minimum of 6 weeks follow-up was available for all patients. The mean (SD) venous plasma, target-site plasma, and target-site tissue concentrations were 36 (13) µg/mL, 29 (13) µg/mL, and 28 (13) µg/g, respectively, and the cefazolin concentrations between the different locations of surgery did not differ significantly in both target-site plasma and target-site tissue (P = 0.822 and P = 0.840). In conclusion, 2 g of prophylactic cefazolin demonstrates adequacy in maintaining coverage for a duration of at least 80 minutes of surgery below the level of the knee, significantly surpassing the MIC90 required to combat the most prevalent microorganisms. This study represents the first of its kind to assess cefazolin concentrations in the lower extremities by examining both plasma and tissue samples in this magnitude.
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Affiliation(s)
- Robin Eelsing
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, the Netherlands
| | - Diederick Penning
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, the Netherlands
| | | | - Caspar J. Hodiamont
- Department of Medical Microbiology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Ron A. A. Mathôt
- Hospital Pharmacy and Clinical Pharmacology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Tim Schepers
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, AMS - Musculoskeletal Health, Amsterdam, the Netherlands
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3
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Tsang STJ, van Rensburg AJ, Ferreira N. Is there a role for suppression of infection in managing fracture-related infection following intra-medullary nailing? Injury 2024; 55:111602. [PMID: 38735275 DOI: 10.1016/j.injury.2024.111602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 12/17/2023] [Accepted: 05/05/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND The management of fracture-related infection has undergone radical progress following the development of international guidelines. However, there is limited consideration to the realities of healthcare in low-resource environments due to a lack of available evidence in the literature from these settings. Initial antimicrobial suppression to support fracture union is frequently used in low- and middle-income countries despite the lack of published clinical evidence to support its practice. This study aimed to evaluate the outcomes following initial antimicrobial suppression to support fracture union in the management of fracture-related infection. METHODS A retrospective review of consecutive patients treated with initial antimicrobial suppression to support fracture healing followed by definitive eradication surgery to manage fracture-related infections following intramedullary fixation was performed. Indications for this approach were; a soft tissue envelope not requiring reconstructive surgery, radiographic evidence of stable fixation with adequate alignment, and progression towards fracture union. RESULTS This approach was associated with successful treatment in 51/55 (93 %) patients. Fracture union was achieved in 52/55 (95 %) patients with antimicrobial suppression alone. Remission of infection was achieved in 54/55 (98 %) patients following definitive infection eradication surgery. Following antibiotic suppression, 6/46 (13 %) pathogens isolated from intra-operative samples demonstrated multi-drug resistance. CONCLUSION Initial antimicrobial suppression to support fracture healing followed by definitive infection eradication surgery was associated with successful treatment in 93 % of patients. The likelihood of remission of infection increases when eradication surgery is performed in a healed bone. This approach was not associated with an increased risk of developing multi-drug-resistant infections compared to contemporary bone infection cohorts in the published literature. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Shao-Ting Jerry Tsang
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, Republic of South Africa
| | - Adrian Jansen van Rensburg
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, Republic of South Africa
| | - Nando Ferreira
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, Republic of South Africa.
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Vicenti G, Buono C, Albano F, Ladogana T, Pesare E, Colasuonno G, Passarelli AC, Solarino G. Early Management for Fracture-Related Infection: A Literature Review. Healthcare (Basel) 2024; 12:1306. [PMID: 38998841 PMCID: PMC11241692 DOI: 10.3390/healthcare12131306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/15/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Fracture-related infections (FRIs), as shown in the literature, represent one of the main complications of trauma surgery. They are a consequence of an implant-related "biofilm" formation and are a challenge for surgeons, microbiologists, and infectious disease specialists. For a correct diagnosis, careful clinical evaluation, to look for signs/symptoms attributable to an infectious condition, and instrumental examinations, to highlight the site of infection, its extent, and its severity, are both essential. Unfortunately, due to the lack of data in the literature, there is no consensus about guidelines on the diagnosis and treatment of FRIs. The purpose of this study is to present an up-to-date concept evaluation of the diagnostic procedures and treatment options available in the management of fracture-related infections.
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Affiliation(s)
| | - Claudio Buono
- Orthopaedic & Trauma Unit, Department of Traslational Biomedicine and Neuroscience (DiBraiN), School of Medicine, University of Bari Aldo Moro, AOU Consorziale “Policlinico”, 70124 Bari, Italy; (G.V.); (F.A.); (T.L.); (E.P.); (G.C.); (A.C.P.); (G.S.)
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5
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Buijs MAS, Haidari S, IJpma FFA, Hietbrink F, Govaert GAM. What can they expect? Decreased quality of life and increased postoperative complication rate in patients with a fracture-related infection. Injury 2024; 55:111425. [PMID: 38402709 DOI: 10.1016/j.injury.2024.111425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 11/05/2023] [Accepted: 02/11/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND By gaining insight into the Quality of Life (QoL) status and occurrence of complications, critical facets in the care for patients with Fracture-Related Infection (FRI) can be mitigated and measures can be taken to improve their outcome. Therefore, the aims of this study were to 1) determine the QoL in FRI patients in comparison to non-FRI patients and 2) describe the occurrence of other complications in both FRI and non-FRI patients. METHODS An ambidirectional cohort study was conducted in a level 1 trauma centre between January 1st 2016 and November 1st 2021. All patients who underwent surgical stabilisation of an isolated long bone fracture were eligible for inclusion. To avoid confounding, only patients with an Injury Severity Score (ISS) <16 were included. Data regarding patient demographics, fracture characteristics, treatment, follow-up and complications were collected of both non-FRI and FRI patients. QoL was assessed through the use of five-level EuroQol five-dimension (EQ-5D-5L) questionnaires twelve months post-injury. RESULTS A total of 134 patients were included in this study, of whom 38 (28%) FRI patients and 96 (72%) non-FRI patients. In comparison to non-FRI patients, FRI patients scored significantly worse on the QoL assessment regarding the index value (p = 0.012) and the domains mobility (p<0.001), usual activities (p = 0.010) and pain/discomfort (p = 0.009). Other postoperative complications were more often reported (p<0.001) in FRI patients (66%, n = 25/38) compared to non-FRI patients (27%, n = 26/96). During the median follow-up of 14.5 months (interquartile range (IQR) 9.5-26.5), 25 FRI patients developed a total of 49 distinctive complications besides FRI. The complications nonunion (18%, n = 9/49), infection other than FRI (e.g. line infection, urinary tract infection, pneumonia) (18%, n = 9/49) and implant failure (14%, n = 7/49) were the most frequently described in the FRI group. CONCLUSION Patients who suffered from an FRI have a decreased QoL in comparison to those without an FRI. Moreover, patients with an FRI have a higher rate of additional complications. These findings can help in patient counselling regarding the potential physical and mental consequences of having a complicated course of recovery due to an infection.
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Affiliation(s)
- M A S Buijs
- Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - S Haidari
- Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - F F A IJpma
- Department of Trauma Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - F Hietbrink
- Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - G A M Govaert
- Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
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Puetzler J, Vallejo Diaz A, Gosheger G, Schulze M, Arens D, Zeiter S, Siverino C, Richards RG, Moriarty TF. Implant retention in a rabbit model of fracture-related infection. Bone Joint Res 2024; 13:127-135. [PMID: 38517016 PMCID: PMC10958740 DOI: 10.1302/2046-3758.133.bjr-2023-0077.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Aims Fracture-related infection (FRI) is commonly classified based on the time of onset of symptoms. Early infections (< two weeks) are treated with debridement, antibiotics, and implant retention (DAIR). For late infections (> ten weeks), guidelines recommend implant removal due to tolerant biofilms. For delayed infections (two to ten weeks), recommendations are unclear. In this study we compared infection clearance and bone healing in early and delayed FRI treated with DAIR in a rabbit model. Methods Staphylococcus aureus was inoculated into a humeral osteotomy in 17 rabbits after plate osteosynthesis. Infection developed for one week (early group, n = 6) or four weeks (delayed group, n = 6) before DAIR (systemic antibiotics: two weeks, nafcillin + rifampin; four weeks, levofloxacin + rifampin). A control group (n = 5) received revision surgery after four weeks without antibiotics. Bacteriology of humerus, soft-tissue, and implants was performed seven weeks after revision surgery. Bone healing was assessed using a modified radiological union scale in tibial fractures (mRUST). Results Greater bacterial burden in the early group compared to the delayed and control groups at revision surgery indicates a retraction of the infection from one to four weeks. Infection was cleared in all animals in the early and delayed groups at euthanasia, but not in the control group. Osteotomies healed in the early group, but bone healing was significantly compromised in the delayed and control groups. Conclusion The duration of the infection from one to four weeks does not impact the success of infection clearance in this model. Bone healing, however, is impaired as the duration of the infection increases.
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Affiliation(s)
- Jan Puetzler
- AO Research Institute Davos, Davos, Switzerland
- Clinic of General Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Münster, Germany
| | - Alejandro Vallejo Diaz
- AO Research Institute Davos, Davos, Switzerland
- Department of Orthopedics and Traumatology, Hospital Alma Mater de Antioquia, Medellín, Colombia
- Department of Orthopedics and Traumatology, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Georg Gosheger
- Clinic of General Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Münster, Germany
| | - Martin Schulze
- Clinic of General Orthopaedics and Tumor Orthopaedics, University Hospital Muenster, Münster, Germany
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Tsang STJ, Ferreira N. The role of implant retention and conservative management in the management of fracture-related infection. J Orthop 2024; 48:47-51. [PMID: 38077474 PMCID: PMC10700830 DOI: 10.1016/j.jor.2023.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 08/03/2024] Open
Abstract
UNLABELLED Fracture-related infection (FRI) management has advanced considerably in recent years, offering new possibilities for predictable rates of infection eradication. Debridement, antibiotics, and implant retention (DAIR) procedures have shown promise in the treatment of early FRI. This article provides an overview of the principles and indications of DAIR, including the importance of meticulous debridement and the management of dead space. The outcomes of DAIR are discussed, highlighting the range of fracture union rates reported in the literature. The role of antimicrobial suppression in optimizing host biology and facilitating surgical intervention is also explored. While further research is needed to establish optimal treatment strategies, DAIR offers a valuable treatment approach for FRI when specific criteria are met. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Shao-Ting Jerry Tsang
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, South Africa
| | - Nando Ferreira
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, South Africa
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8
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Rupp M, Walter N, Bärtl S, Heyd R, Hitzenbichler F, Alt V. Fracture-Related Infection-Epidemiology, Etiology, Diagnosis, Prevention, and Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:17-24. [PMID: 37970721 PMCID: PMC10916768 DOI: 10.3238/arztebl.m2023.0233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Fracture-related infection (FRI) is a challenge to physicians and other workers in health care. In 2018, there were 7253 listed cases of FRI in Germany, corresponding to an incidence of 10.7 cases per 100 000 persons per year. METHODS This review is based on pertinent publications retrieved from a search in PubMed with the search terms "fracture," "infection," "guideline," and "consensus." Aside from the primary literature, international guidelines and consensus recommendations were evaluated as well. RESULTS FRI arise mainly from bacterial contamination of the fracture site. Staphylococcus aureus is the most commonly detected pathogen. The treatment is based on surgery and antibiotics and should be agreed upon by an interdisciplinary team; it is often difficult because of biofilm formation. Treatment options include implant-preserving procedures and single-stage, two-stage, or multi-stage implant replacement. Treatment failure occurs in 10.3% to 21.4% of cases. The available evidence on the efficacy of various treatment approaches is derived mainly from retrospective cohort studies (level III evidence). Therefore, periprosthetic joint infections and FRI are often discussed together. CONCLUSION FRI presents an increasing challenge. Preventive measures should be optimized, and the treatment should always be decided upon by an interdisciplinary team. Only low-level evidence is available to date to guide diagnostic and treatment decisions. High-quality studies are therefore needed to help us meet this challenge more effectively.
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Affiliation(s)
- Markus Rupp
- These authors share first authorship
- Department for Trauma surgery, University Hospital Regensburg, Germany
| | - Nike Walter
- These authors share first authorship
- Department for Trauma surgery, University Hospital Regensburg, Germany
| | - Susanne Bärtl
- Department for Trauma surgery, University Hospital Regensburg, Germany
| | - Robert Heyd
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Germany
| | - Florian Hitzenbichler
- Department for Hospital hygiene and Infectiology, University Hospital Regensburg, Germany
| | - Volker Alt
- Department for Trauma surgery, University Hospital Regensburg, Germany
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9
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Casiraghi A, Galante C, Rohayem M, Vittone G, Domenicucci M, Cattaneo S, Paderno M, Grava G, Van Hauwermeiren E, Milano G. Implant retention with serial debridement and use of antibiotic-loaded calcium sulfate beads in acute fracture-related infection (FRI) after pelvic ring or acetabular fractures: A retrospective case series of 7 cases. Injury 2023; 54:1082-1087. [PMID: 36740475 DOI: 10.1016/j.injury.2023.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND The development of a pelvic wound infection in the presence of hardware after open reduction and internal fixation presents a clinical dilemma and there is little literature to aid in decision-making. The purpose of this study was to describe the possibility of debridement, antibiotic pearls and retention of the implant (DAPRI) procedure to eradicate the infection. METHODS Tumor-like debridement, antibiotic pearls and retention of the implant (DAPRI) aimed to remove the biofilm allowing a higher and prolonged local antibiotic concentration by using calcium sulfate antibiotic-added beads. Wound status, radiological signs of bone healing, gait and functional activity of the patient were evaluated. RESULTS Seven patients underwent this technique. The mean follow up time was nine months (range: 6 -16 months). Complete wound healing was achieved in all the patients with no major complications. Average time of bony union was 4.3 months (range: 3-6 months) with no need for implant removal. CONCLUSION The DAPRI technique might represent a safe and more conservative treatment for management of early fracture-related infections (FRI) of the pelvis and acetabulum.
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Affiliation(s)
| | - Claudio Galante
- Department of Bone and Joint Surgery, ASST Spedali Civili, Brescia, Italy.
| | - Mohamed Rohayem
- Orthopedic surgery department, Tanta University Hospitals, Egypt
| | - Giulio Vittone
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Domenicucci
- Department of Bone and Joint Surgery, ASST Spedali Civili, Brescia, Italy
| | - Stefano Cattaneo
- Department of Bone and Joint Surgery, ASST Spedali Civili, Brescia, Italy
| | - Marco Paderno
- Department of Bone and Joint Surgery, ASST Spedali Civili, Brescia, Italy
| | - Giuseppe Grava
- Department of Bone and Joint Surgery, ASST Spedali Civili, Brescia, Italy
| | | | - Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Rupp M, Walter N, Popp D, Hitzenbichler F, Heyd R, Geis S, Kandulski M, Thurn S, Betz T, Brochhausen C, Alt V. Multidisciplinary Treatment of Fracture-Related Infection Has a Positive Impact on Clinical Outcome-A Retrospective Case Control Study at a Tertiary Referral Center. Antibiotics (Basel) 2023; 12:antibiotics12020230. [PMID: 36830141 PMCID: PMC9952612 DOI: 10.3390/antibiotics12020230] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Fracture-related infection (FRI) is a major complication in orthopedic and trauma surgery. The management and choice of treatment can be difficult depending on multiple factors. Therefore, we implemented a weekly multidisciplinary team discussion to determine diagnostic and treatment strategies in FRI patients and aimed to analyze its effect on clinical outcomes. METHODS Clinical outcomes of FRI patients treated before and after implementation of a structured multidisciplinary treatment (MDT) approach with a weekly case discussion were compared at a follow-up of 12 months. RESULTS In total, n = 117 were eligible for enrolment, whereby n = 58 patients (72.4% male, mean age 56.7 ± 16.8 years) constituted the MDT group and n = 59 patients (72.9% male, mean age 55.0 ± 16.5 years) the control group. In the MDT group more cases were treated with local antibiotics (67.2% vs. 27.1%, p < 0.001) and significant less amputations (3.4% vs. 6.8%, p = 0.014), as well as less revision surgeries (1.5 ± 1.2 (0-5) vs. 2.2 ± 1.2 (0-7), p = 0.048) were performed. A trend towards less debridement, antibiotics and implant retention (DAIR) procedures, lower rates of recurrence of infection and less treatment failures in the MDT group was observable, even though not statistically significant. CONCLUSION An MDT approach providing a patient tailored treatment concept in the treatment of FRI patients appears to be beneficial for the affected patients. Quality and efficacy of implemented MDT meetings should further be evaluated to provide sufficient evidence to further implement this valuable tool in clinical practice and decision making.
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Affiliation(s)
- Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
- Correspondence: (M.R.); (N.W.)
| | - Nike Walter
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
- Department for Psychosomatic Medicine, University Hospital Regensburg, 93053 Regensburg, Germany
- Correspondence: (M.R.); (N.W.)
| | - Daniel Popp
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Florian Hitzenbichler
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Robert Heyd
- Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Sebastian Geis
- Center of Plastic and Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Melanie Kandulski
- Department of Internal Medicine I, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Sylvia Thurn
- Institute of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Thomas Betz
- Department of Vascular Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Christoph Brochhausen
- Institute of Pathology, University Regensburg, 93053 Regensburg, Germany
- Institute of Pathology, University Medical Center, 68167 Mannheim, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
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