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Patel KH, Gill LI, Tissingh EK, Galanis A, Hadjihannas I, Iliadis AD, Heidari N, Cherian B, Rosmarin C, Vris A. Microbiological Profile of Fracture Related Infection at a UK Major Trauma Centre. Antibiotics (Basel) 2023; 12:1358. [PMID: 37760655 PMCID: PMC10525273 DOI: 10.3390/antibiotics12091358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/11/2023] [Accepted: 07/26/2023] [Indexed: 09/29/2023] Open
Abstract
Fracture Related Infection (FRI) represents one of the biggest challenges for Trauma and Orthopaedic surgery. A better understanding of the microbiological profile should assist with decision-making and optimising outcomes. Our primary aim was to report on the microbiological profile of FRI cases treated over a six-year period at one of Europe's busiest trauma centres. Secondarily, we sought to correlate our findings with existing anti-microbiological protocols and report on diagnostic techniques employed in our practice. All adult cases of FRI treated in our institution between 2016 and 2021 were identified, retrospectively. We recorded patient demographics, diagnostic strategies, causative organisms and antibiotic susceptibilities. There were 330 infection episodes in 294 patients. A total of 463 potentially pathogenic organisms (78 different species) were identified from cultures, of which 57.2% were gram-positive and 39.7% gram-negative. Polymicrobial cultures were found in 33.6% of cases and no causative organism was found in 17.5%. The most prevalent organisms were Staphylococcus aureus (24.4%), coagulase-negative Staphylococci (14%), Pseudomonas aeruginosa (8.2%), Enterobacter species (7.8%) and Escherichia coli (6.9%). Resistant gram-positive organisms (methicillin resistant Staphylococcus aureus or vancomycin-resistant Enterococci) were implicated in 3.3% of infection episodes and resistant gram-negatives (extended-spectrum beta-lactamase, ampC or carbapenemase-producing bacteria) in 13.6%. The organisms cultured in 96.3% of infection episodes would have been covered by our empirical systemic antibiotic choice of teicoplanin and meropenem. To our knowledge, this is the largest reported single-centre cohort of FRIs from a major trauma centre. Our results demonstrate patterns in microbiological profiles that should serve to inform the decision-making process regarding antibiotic choices for both prophylaxis and treatment.
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Affiliation(s)
- Kavi H. Patel
- Limb Reconstruction and Bone Infection Service, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1FR, UK; (E.K.T.); (A.D.I.); (N.H.); (A.V.)
| | - Laura I. Gill
- Department of Infection, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1FR, UK; (L.I.G.); (B.C.); (C.R.)
| | - Elizabeth K. Tissingh
- Limb Reconstruction and Bone Infection Service, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1FR, UK; (E.K.T.); (A.D.I.); (N.H.); (A.V.)
| | | | - Ioannis Hadjihannas
- Barts and the London School of Medicine, Garrod Building, Turner St., London E1 2AD, UK;
| | - Alexis D. Iliadis
- Limb Reconstruction and Bone Infection Service, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1FR, UK; (E.K.T.); (A.D.I.); (N.H.); (A.V.)
| | - Nima Heidari
- Limb Reconstruction and Bone Infection Service, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1FR, UK; (E.K.T.); (A.D.I.); (N.H.); (A.V.)
| | - Benny Cherian
- Department of Infection, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1FR, UK; (L.I.G.); (B.C.); (C.R.)
| | - Caryn Rosmarin
- Department of Infection, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1FR, UK; (L.I.G.); (B.C.); (C.R.)
| | - Alexandros Vris
- Limb Reconstruction and Bone Infection Service, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1FR, UK; (E.K.T.); (A.D.I.); (N.H.); (A.V.)
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