Risk Factors and Infection Presentation of Gram-Negative Fracture Related Infections.

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Trauma Care

Background:

• Fracture-related infections (FRIs) pose significant challenges in orthopedic trauma care.
• Gram-negative (GN) bacteria are increasingly recognized as important pathogens in FRIs.

Purpose of the Study:

• To identify factors associated with GN FRIs.
• To evaluate the impact of GN infections on treatment and outcomes of FRIs.

Main Methods:

• Retrospective cohort study at a Level I Trauma Center.
• Inclusion of all extremity FRIs patients between 2013-2020.
• Univariate analysis comparing Gram-negative (GN) vs. Gram-positive (GP) FRIs, and a three-group analysis (GN only, GP only, polymicrobial GN with GP).

Main Results:

• 299 patients were analyzed; 25% had GN microbes.
• GN FRIs were associated with male sex, multisystem trauma, external fixation, skin grafting, and flap coverage.
• Higher rates of amputation were observed in GN FRI patients (15% vs. 6% for GP only).
• Nonunion rates (20% vs. 22%) and reoperation rates were similar between GN and GP groups.

Conclusions:

• Male sex, multisystem trauma, external fixation, and need for advanced soft tissue coverage are risk factors for GN FRIs.
• GN FRIs do not increase nonunion rates but are associated with a higher likelihood of amputation compared to GP-only infections.