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Orthopaedic infections: what have we learned?
Christopher Lee1, Erik Mayer1, Nicholas Bernthal1
1Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA.
Abstract:
Orthopaedic infections remain challenging complications to treat, with profound economic impact in addition to patient morbidity. The overall estimates of infection after orthopaedic surgery with internal devices has been estimated at 5%, with hospital costs eight times that of those without fracture-related infections and with significantly poorer functional and pain interference PROMIS scores. Orthopaedic infection interventions have been focused on prevention and treatment options. The creation of new modalities for orthopaedic infection treatment can benefit from the understanding of the temporal relationship between bacterial colonization and host-cell integration, a concept referred to as "the race for the surface." Regarding prevention, host modulation and antibiotic powder use have been explored as viable options to lower infection rates. Orthopaedic infection treatment has additionally continued to evolve, with PO antibiotics demonstrating equivalent efficacy to IV antibiotics for the treatment of orthopaedic infections in recent studies. In conclusion, orthopaedic infections remain difficult clinical dilemmas, although evolving prevention and treatment modalities continue to emerge.
Insights
Orthopaedic infections pose significant challenges, impacting patient health and increasing costs. Emerging prevention and treatment strategies, including oral antibiotics, offer improved outcomes for these difficult-to-treat conditions.
Area of Science:
- Orthopaedic surgery
- Infectious diseases
- Biomedical engineering
Background:
- Orthopaedic infections are a major complication following surgery with internal devices, affecting approximately 5% of patients.
- These infections lead to significantly higher hospital costs and poorer patient outcomes, including reduced function and increased pain.
- Understanding the "race for the surface"—the temporal relationship between bacterial colonization and host-cell integration—is crucial for developing new treatments.
Purpose of the Study:
- To review current and emerging strategies for the prevention and treatment of orthopaedic infections.
- To highlight advancements in understanding the pathogenesis of these infections.
- To discuss the evolving landscape of therapeutic options.
Main Methods:
- Review of existing literature on orthopaedic infection prevention and treatment.
- Analysis of recent studies on antibiotic efficacy and novel therapeutic approaches.
- Exploration of host modulation and antibiotic powder use for prevention.
Main Results:
- Oral antibiotics show comparable efficacy to intravenous antibiotics for orthopaedic infections.
- Host modulation and antibiotic powders are promising for infection prevention.
- Understanding bacterial-host interactions is key to new treatment development.
Conclusions:
- Orthopaedic infections remain a complex clinical challenge requiring ongoing research and innovation.
- Evolving prevention strategies, such as host modulation and antibiotic powders, show promise in reducing infection rates.
- Advancements in treatment, including the use of oral antibiotics, are improving patient outcomes.
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