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Recommendations for Systemic Antimicrobial Therapy in Fracture-Related Infection: A Consensus From an International
Melissa Depypere1, Richard Kuehl2, Willem-Jan Metsemakers3
1Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.
Abstract:
Fracture-related infection (FRI) is a major complication in musculoskeletal trauma and one of the leading causes of morbidity. Standardization of general treatment strategies for FRI has been poor. One of the reasons is the heterogeneity in this patient population, including various anatomical locations, multiple fracture patterns, different degrees of soft-tissue injury, and different patient conditions. This variability makes treatment complex and hard to standardize. As these infections are biofilm-related, surgery remains the cornerstone of treatment, and this entails multiple key aspects (eg, fracture fixation, tissue sampling, debridement, and soft-tissue management). Another important aspect, which is sometimes less familiar to the orthopaedic trauma surgeon, is systemic antimicrobial therapy. The aim of this article is to summarize the available evidence and provide recommendations for systemic antimicrobial therapy with respect to FRI, based on the most recent literature combined with expert opinion. LEVEL OF EVIDENCE:: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
Insights
Fracture-related infections (FRIs) are complex due to patient variability. This review provides evidence-based recommendations for systemic antimicrobial therapy in managing FRIs.
Area of Science:
- Orthopaedic surgery
- Infectious diseases
- Musculoskeletal trauma
Background:
- Fracture-related infection (FRI) is a significant complication of musculoskeletal trauma, leading to high morbidity.
- Current treatment strategies for FRI lack standardization due to patient and injury heterogeneity.
- Biofilm formation is central to FRI pathogenesis, making surgical intervention crucial.
Purpose of the Study:
- To summarize current evidence on systemic antimicrobial therapy for FRI.
- To provide expert-opinion-based recommendations for managing FRI-related infections.
- To address the complexities of antimicrobial treatment in diverse FRI cases.
Main Methods:
- Systematic review of recent literature.
- Integration of expert clinical opinion.
- Focus on systemic antimicrobial therapy in the context of surgical management.
Main Results:
- Surgery, including debridement and fixation, is the cornerstone of FRI treatment.
- Systemic antimicrobial therapy is a critical, though sometimes underemphasized, component of FRI management.
- Recommendations are based on the latest evidence and consensus.
Conclusions:
- Standardized systemic antimicrobial therapy protocols are needed for fracture-related infections.
- Effective management requires a comprehensive approach combining surgical expertise and appropriate antibiotic strategies.
- Further research and consensus-building are essential for optimizing FRI treatment outcomes.
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