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Causative Pathogens Do Not Differ between Early, Delayed or Late Fracture-Related Infections
Ruth A Corrigan1,2, Jonathan Sliepen3, Maria Dudareva1
1Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford OX3 7HE, UK.
Antibiotics (Basel, Switzerland)
|July 27, 2022
Summary
Fracture-related infections (FRIs) are classified by time, but this study found no significant differences in causative pathogens over time. Treatment decisions for FRIs should not rely on infection timing alone.
Area of Science:
- Orthopedics
- Infectious Diseases
- Microbiology
Background:
- Fracture-related infections (FRIs) are traditionally categorized as early, delayed, or late based on time since injury.
- This classification assumes distinct causative pathogens and biofilm formation over time.
- Treatment strategies, such as debridement, antimicrobial therapy, and implant retention (DAIR), are often tailored to these time-based categories.
Purpose of the Study:
- To investigate whether the types of pathogens isolated from FRIs differ significantly across early, delayed, and late infection timelines.
- To determine if the traditional time-based classification of FRIs has a microbiological basis.
- To inform treatment strategies by clarifying the relationship between FRI timing and causative pathogens.
Main Methods:
- A retrospective analysis of 433 FRIs managed surgically across three centers between 2015-2019.
- Data collected included patient demographics, time from injury to management, and isolated pathogens.
- Statistical analysis was performed to compare pathogen types across early (0-2 weeks), delayed (3-10 weeks), and late (>10 weeks) infection groups, including analysis of patients undergoing DAIR.
Main Results:
- While infection type showed some association with time (polymicrobial in early/delayed, culture-negative/monomicrobial in late), the specific pathogens isolated were not significantly different across the time categories (p=0.2).
- Staphylococcus aureus was the most common pathogen overall, found at all time points.
- No evidence supported the hypothesis of more virulent pathogens in early infections or less virulent ones in late infections.
Conclusions:
- The microbiological profile of fracture-related infections does not appear to differ significantly based on the time since injury.
- The traditional classification of FRIs into early, delayed, and late categories may lack a strong microbiological justification.
- Treatment decisions for FRIs should not be solely based on the presumed microbiological differences related to the timing of infection.
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