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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.
Involved Institutions
Details
| Item type | Article | ||||
| Journal or Publication Title | Antibiotics | ||||
| Publisher: | MDPI | ||||
|---|---|---|---|---|---|
| Place of Publication: | BASEL | ||||
| Volume: | 11 | ||||
| Number of Issue or Book Chapter: | 3 | ||||
| Page Range: | p. 287 | ||||
| Date | 22 February 2022 | ||||
| Institutions | Medicine > Lehrstuhl für Unfallchirurgie Medicine > Abteilung für Krankenhaushygiene und Infektiologie Medicine > Abteilung für Krankenhaushygiene und Infektiologie | ||||
| Identification Number |
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| Keywords | BONE; PROPHYLAXIS; GENTAMICIN; FLUCLOXACILLIN; CEMENT; HIP; fracture-related infection; antimicrobial resistance; empiric antibiotic treatment | ||||
| Dewey Decimal Classification | 600 Technology > 610 Medical sciences Medicine | ||||
| Status | Published | ||||
| Refereed | Yes, this version has been refereed | ||||
| Created at the University of Regensburg | Yes | ||||
| URN of the UB Regensburg | urn:nbn:de:bvb:355-epub-521786 | ||||
| Item ID | 52178 |
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