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Is There a Difference in Microbiological Epidemiology and Effective Empiric Antimicrobial Therapy Comparing
Markus Rupp1, Susanne Baertl1, Nike Walter1
1Department for Trauma Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany.
Abstract:
This study aims to investigate (1) microbial patterns in fracture-related infections (FRIs) in comparison to microbiological patterns of periprosthetic joint infections (PJIs), (2) the identification of effective empiric antibiotic therapy for FRIs and PJIs and (3) analysis of difficult-to-treat (DTT) pathogens. Patients treated for FRIs or PJIs from 2017 to 2020 were evaluated for pathogens detected during treatment. Antibiotic susceptibility profiles were examined with respect to broadly used antibiotics and antibiotic combinations. Resistance rates to rifampicin or fluoroquinolone were determined. A total of 81 patients with PJI and 86 with FRI were included in the study. For FRIs Staphylococcus aureus was the most common infection-causing pathogen (37.4% vs. 27.9% for PJI). Overall, there was no statistical difference in pathogen distribution (p = 0.254). For FRIs, combinations of gentamicin + vancomycin (93.2%), co-amoxiclav + glycopeptide and meropenem + vancomycin (91.9% each) would have been effective for empiric therapy, similar to PJIs. Difficult to treat pathogens were more frequently detectable in PJIs (11.6% vs. 2.3%). Empiric therapy combinations such as gentamicin + vancomycin, co-amoxiclav + glycopeptide or meropenem + vancomycin, are effective antibiotic strategies for both FRI and PJI patients. More DTT pathogens were detectable in PJIs compared to FRIs.
Insights
Effective empiric antibiotic combinations, including gentamicin + vancomycin, are recommended for both fracture-related infections (FRIs) and periprosthetic joint infections (PJIs). Difficult-to-treat pathogens were more common in PJIs.
Area of Science:
- Orthopedics
- Infectious Diseases
- Microbiology
Background:
- Fracture-related infections (FRIs) and periprosthetic joint infections (PJIs) are significant orthopedic challenges.
- Understanding microbial patterns and effective antibiotic strategies is crucial for patient outcomes.
Purpose of the Study:
- Compare microbial patterns in FRIs versus PJIs.
- Identify effective empiric antibiotic therapies for both infection types.
- Analyze the prevalence of difficult-to-treat (DTT) pathogens.
Main Methods:
- Retrospective analysis of patients treated for FRIs or PJIs between 2017 and 2020.
- Evaluation of detected pathogens and antibiotic susceptibility profiles.
- Determination of resistance rates to key antibiotics like rifampicin and fluoroquinolones.
Main Results:
- Staphylococcus aureus was the most common pathogen in FRIs (37.4%).
- No significant statistical difference in overall pathogen distribution between FRIs and PJIs (p=0.254).
- Effective empiric antibiotic combinations for FRIs included gentamicin + vancomycin (93.2%) and co-amoxiclav + glycopeptide or meropenem + vancomycin (91.9% each).
- Difficult-to-treat pathogens were more frequent in PJIs (11.6%) compared to FRIs (2.3%).
Conclusions:
- Empiric antibiotic combinations like gentamicin + vancomycin, co-amoxiclav + glycopeptide, and meropenem + vancomycin are effective for both FRI and PJI.
- PJIs present a higher burden of difficult-to-treat pathogens compared to FRIs.
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