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Baertl, Susanne ; Walter, Nike ; Engelstaedter, Ulrike ; Ehrenschwender, Martin ; Hitzenbichler, Florian ; Alt, Volker ; Rupp, Markus

What Is the Most Effective Empirical Antibiotic Treatment for Early, Delayed, and Late Fracture-Related Infections?

Baertl, Susanne , Walter, Nike , Engelstaedter, Ulrike , Ehrenschwender, Martin , Hitzenbichler, Florian , Alt, Volker and Rupp, Markus (2022) What Is the Most Effective Empirical Antibiotic Treatment for Early, Delayed, and Late Fracture-Related Infections? Antibiotics 11 (3), p. 287.

Date of publication of this fulltext: 26 Apr 2022 15:07
Article
DOI to cite this document: 10.5283/epub.52178


Abstract

Antibiotic treatment strategies for fracture-related infections (FRI) are often extrapolated from periprosthetic joint infections (PJI), although, in contrast to PJI, detailed analysis of pathogens and their antibiotic resistance is missing. Therefore, this study aimed to investigate antibiotic susceptibility profiles to identify effective empiric antibiotic treatment for early-, delayed-, and ...

Antibiotic treatment strategies for fracture-related infections (FRI) are often extrapolated from periprosthetic joint infections (PJI), although, in contrast to PJI, detailed analysis of pathogens and their antibiotic resistance is missing. Therefore, this study aimed to investigate antibiotic susceptibility profiles to identify effective empiric antibiotic treatment for early-, delayed-, and late-onset FRI. Patients treated for FRI from 2013 to 2020 were grouped into early (<2 weeks), delayed (3-10 weeks), and late (>10 weeks) onset of infection. Antibiotic susceptibility profiles were examined with respect to broadly used antibiotics and antibiotic combinations. In total, 117 patients (early n = 19, delayed n = 60, late n = 38) were enrolled. In early-onset FRI, 100.0% efficacy would be achieved by meropenem + vancomycin, gentamicin + vancomycin, co-amoxiclav + glycopeptide, ciprofloxacin + glycopeptide and piperacillin/tazobactam + glycopeptide. For patients with delayed FRI, the highest susceptibility was revealed for meropenem + vancomycin, gentamicin + vancomycin and ciprofloxacin + glycopeptide (96.7%). Meropenem + vancomycin was the most effective empiric antimicrobial in patients with late-onset of infection with 92.1% coverage. No subgroup differences in antibiotic sensitivity profiles were observed except for the combination ciprofloxacin + glycopeptide, which was significantly superior in early FRI (F = 3.304, p = 0.04). Across all subgroups meropenem + vancomycin was the most effective empiric treatment in 95.7% of patients with confirmed susceptibility. Meropenem + vancomycin, gentamicin + vancomycin, co-amoxiclav + glycopeptide are the best therapeutic options for FRI, regardless of the onset of infection. To avoid multidrug resistance, established antibiotic combinations such as co-amoxiclav with a glycopeptide seem to be reasonable as a systemic antibiotic therapy, while vancomycin + gentamicin could be implemented in local antibiotic therapy to reduce adverse events during treatment.



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Details

Item typeArticle
Journal or Publication TitleAntibiotics
Publisher:MDPI
Place of Publication:BASEL
Volume:11
Number of Issue or Book Chapter:3
Page Range:p. 287
Date22 February 2022
InstitutionsMedicine > Lehrstuhl für Unfallchirurgie
Medicine > Abteilung für Krankenhaushygiene und Infektiologie
Medicine > Abteilung für Krankenhaushygiene und Infektiologie
Identification Number
ValueType
10.3390/antibiotics11030287DOI
KeywordsBONE; PROPHYLAXIS; GENTAMICIN; FLUCLOXACILLIN; CEMENT; HIP; fracture-related infection; antimicrobial resistance; empiric antibiotic treatment
Dewey Decimal Classification600 Technology > 610 Medical sciences Medicine
StatusPublished
RefereedYes, this version has been refereed
Created at the University of RegensburgYes
URN of the UB Regensburgurn:nbn:de:bvb:355-epub-521786
Item ID52178

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