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54. The effect of guideline-based antimicrobial therapy on the outcome of fracture-related infections (EAT FRI Study)

Author

Infection & Immunity, Zorgeenheid Traumatologie, Corrigan, Ruth, Sliepen, Jonathan, Rentenaar, Rob J, IJpma, Frank, Hietbrink, Falco, Atkins, Bridget L, Dudareva, Maria, Govaert, Geertje Am, McNally, Martin A, Wouthuyzen-Bakker, Marjan, Infection & Immunity, Zorgeenheid Traumatologie, Corrigan, Ruth, Sliepen, Jonathan, Rentenaar, Rob J, IJpma, Frank, Hietbrink, Falco, Atkins, Bridget L, Dudareva, Maria, Govaert, Geertje Am, McNally, Martin A, and Wouthuyzen-Bakker, Marjan

Published
2023

55. Diagnosis of fracture-related infection in patients without clinical confirmatory criteria:an international retrospective cohort study

Author

Vanvelk, Niels, Van Lieshout, Esther M.M., Onsea, Jolien, Sliepen, Jonathan, Govaert, Geertje, Ijpma, Frank F.A., Depypere, Melissa, Ferguson, Jamie, Mcnally, Martin, Obremskey, William T., Zalavras, Charalampos, Verhofstad, Michael H.J., Metsemakers, Willem Jan, Vanvelk, Niels, Van Lieshout, Esther M.M., Onsea, Jolien, Sliepen, Jonathan, Govaert, Geertje, Ijpma, Frank F.A., Depypere, Melissa, Ferguson, Jamie, Mcnally, Martin, Obremskey, William T., Zalavras, Charalampos, Verhofstad, Michael H.J., and Metsemakers, Willem Jan

Abstract

Background: fracture-related infection (FRI) remains a serious complication in orthopedic trauma. To standardize daily clinical practice, a consensus definition was established, based on confirmatory and suggestive criteria. In the presence of clinical confirmatory criteria, the diagnosis of an FRI is evident, and treatment can be started. However, if these criteria are absent, the decision to surgically collect deep tissue cultures can only be based on suggestive criteria. The primary study aim was to characterize the subpopulation of FRI patients presenting without clinical confirmatory criteria (fistula, sinus, wound breakdown, purulent wound drainage or presence of pus during surgery). The secondary aims were to describe the prevalence of the diagnostic criteria for FRI and present the microbiological characteristics, both for the entire FRI population. Methods: a multicenter, retrospective cohort study was performed, reporting the demographic, clinical and microbiological characteristics of 609 patients (with 613 fractures) who were treated for FRI based on the recommendations of a multidisciplinary team. Patients were divided in three groups, including the total population and two subgroups of patients presenting with or without clinical confirmatory criteria. Results: clinical and microbiological confirmatory criteria were present in 77g and 87g of the included fractures, respectively. Of patients, 23g presented without clinical confirmatory criteria, and they mostly displayed one (31g) or two (23g) suggestive clinical criteria (redness, swelling, warmth, pain, fever, new-onset joint effusion, persisting/increasing/new-onset wound drainage). The prevalence of any suggestive clinical, radiological or laboratory criteria in this subgroup was 85g, 55g and 97g, respectively. Most infections were monomicrobial (64g) and caused by Staphylococcus aureus. Conclusion: clinical confirmatory criteria were absent in 23g of the FRIs. In these cases, the decision to ope

Published
2023

56. The Sinus Tract in Bone and Joint Infection: Minimally Invasive Salvation or Prolonged Suffering? A Multicenter Study

Author

Klim, Sebastian Martin, primary, Amerstorfer, Florian, additional, McNally, Martin A., additional, Trebse, Rihard, additional, Slokar, Urban, additional, Sigmund, Irene Katharina, additional, Hecker, Andrzej, additional, Reinbacher, Patrick, additional, Leitner, Lukas, additional, Bernhardt, Gerwin Alexander, additional, Leithner, Andreas, additional, Wanko, Sophie, additional, and Glehr, Mathias, additional

Published
2023
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57. Diagnosis of fracture-related infection in patients without clinical confirmatory criteria: an international retrospective cohort study

Author

Vanvelk, Niels, primary, Van Lieshout, Esther M. M., additional, Onsea, Jolien, additional, Sliepen, Jonathan, additional, Govaert, Geertje, additional, IJpma, Frank F. A., additional, Depypere, Melissa, additional, Ferguson, Jamie, additional, McNally, Martin, additional, Obremskey, William T., additional, Zalavras, Charalampos, additional, Verhofstad, Michael H. J., additional, and Metsemakers, Willem-Jan, additional

Published
2023
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64. The European Bone and Joint Infection Society definition of periprosthetic joint infection is meaningful in clinical practice: a multicentric validation study with comparison with previous definitions

Author

Sousa, Ricardo, primary, Ribau, Ana, additional, Alfaro, Pedro, additional, Burch, Marc-Antoine, additional, Ploegmakers, Joris, additional, McNally, Martin, additional, Clauss, Martin, additional, Wouthuyzen-Bakker, Marjan, additional, and Soriano, Alex, additional

Published
2023
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68. Can we predict outcome after treatment of long bone osteomyelitis?

Author

Hotchen, Andrew J., Dudareva, Maria, Corrigan, Ruth A., Ferguson, Jamie Y., and McNally, Martin A.

Abstract

AimsThis study presents patient-reported quality of life (QoL) over the first year following surgical debridement of long bone osteomyelitis. It assesses the bone involvement, antimicrobial options, coverage of soft tissues, and host status (BACH) classification as a prognostic tool and its ability to stratify cases into ‘uncomplicated’ or ‘complex’.MethodsPatients with long-bone osteomyelitis were identified prospectively between June 2010 and October 2015. All patients underwent surgical debridement in a single-staged procedure at a specialist bone infection unit. Self-reported QoL was assessed prospectively using the three-level EuroQol five-dimension questionnaire (EQ-5D-3L) index score and visual analogue scale (EQ-VAS) at five postoperative time-points (baseline, 14 days, 42 days, 120 days, and 365 days). BACH classification was applied retrospectively by two clinicians blinded to outcome.ResultsIn total, 71 patients with long-bone osteomyelitis were included. There was significant improvement from time of surgery to one year postoperatively in mean EQ-VAS (58.2 to 78.9; p < 0.001) and mean EQ-5D-3L index scores (0.284 to 0.740; p < 0.001). At one year following surgery, BACH ‘uncomplicated’ osteomyelitis was associated with better QoL compared to BACH ‘complex’ osteomyelitis (mean EQ-5D-3L 0.900 vs 0.685; p = 0.020; mean EQ-VAS 87.1 vs 73.6; p = 0.043). Patients with uncomplicated bone involvement (BACH type B1, cavitary) reported higher QoL at all time-points when compared to complex bone involvement (B2, segmental or B3, osteomyelitis involving a joint). Patients with good antimicrobial options (Ax or A1) gave higher outcome scores compared to patients with multidrug-resistant isolates (A2). The need for microvascular tissue transfer (C1 and C2) did not impact significantly on QoL. Patients without major comorbidities (uncomplicated, H1) reported higher QoL compared to those with significant disease (complex, H2).ConclusionUncomplicated osteomyelitis, as defined by BACH, gave higher self-reported QoL when compared to complex cases. The bone involvement, antimicrobial options, and host status variables were able to stratify patients in terms of QoL. These data can be used to offer prognostic information to patients who are undergoing treatment for long bone osteomyelitis.

Published
2024
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69. Ein Vergleich von drei Infektionsdefinitionen in der Diagnostik von periprothetischen Gelenkinfektionen

Author

Sigmund, Irene Katharina, Luger, Markus, Windhager, Reinhard, and McNally, Martin

Subjects
Kriterien, periprothetische Gelenkinfektion, IDSA, Infektionsdefinition, Medicine and health, EBJIS, ICM
Abstract

Fragestellung: Die Diagnostik von periprothetischen Gelenkinfektionen (PPI) (vor allem verursacht durch niedrig-virulente Mikroorganismen) stellt weiterhin eine Herausforderung dar. Da es gegenwärtig keine präzise Testmethode mit einer 100%igen Genauigkeit respektive Sensitivität [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Published
2022
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85. Does the Use of Local Antibiotics Affect Clinical Outcome of Patients with Fracture-Related Infection?

Author

Infection & Immunity, Zorgeenheid Traumatologie, Sliepen, Jonathan, Corrigan, Ruth A, Dudareva, Maria, Wouthuyzen-Bakker, Marjan, Rentenaar, Rob J, Atkins, Bridget L, Govaert, Geertje A M, McNally, Martin A, IJpma, Frank F A, Infection & Immunity, Zorgeenheid Traumatologie, Sliepen, Jonathan, Corrigan, Ruth A, Dudareva, Maria, Wouthuyzen-Bakker, Marjan, Rentenaar, Rob J, Atkins, Bridget L, Govaert, Geertje A M, McNally, Martin A, and IJpma, Frank F A

Published
2022

86. What Factors Affect Outcome in the Treatment of Fracture-Related Infection?

Author

MMB Medische Staf, Infection & Immunity, Zorgeenheid Traumatologie, McNally, Martin, Corrigan, Ruth, Sliepen, Jonathan, Dudareva, Maria, Rentenaar, Rob, IJpma, Frank, Atkins, Bridget L, Wouthuyzen-Bakker, Marjan, Govaert, Geertje, MMB Medische Staf, Infection & Immunity, Zorgeenheid Traumatologie, McNally, Martin, Corrigan, Ruth, Sliepen, Jonathan, Dudareva, Maria, Rentenaar, Rob, IJpma, Frank, Atkins, Bridget L, Wouthuyzen-Bakker, Marjan, and Govaert, Geertje

Published
2022

87. Causative Pathogens Do Not Differ between Early, Delayed or Late Fracture-Related Infections

Author

Zorgeenheid Traumatologie, Corrigan, Ruth A, Sliepen, Jonathan, Dudareva, Maria, IJpma, Frank F A, Govaert, Geertje, Atkins, Bridget L, Rentenaar, Rob, Wouthuyzen-Bakker, Marjan, McNally, Martin, Zorgeenheid Traumatologie, Corrigan, Ruth A, Sliepen, Jonathan, Dudareva, Maria, IJpma, Frank F A, Govaert, Geertje, Atkins, Bridget L, Rentenaar, Rob, Wouthuyzen-Bakker, Marjan, and McNally, Martin

Published
2022

88. Clinical Metagenomic Sequencing for Species Identification and Antimicrobial Resistance Prediction in Orthopedic Device Infection

Author

Street, Teresa L., primary, Sanderson, Nicholas D., additional, Kolenda, Camille, additional, Kavanagh, James, additional, Pickford, Hayleah, additional, Hoosdally, Sarah, additional, Cregan, Jack, additional, Taunt, Carol, additional, Jones, Emma, additional, Oakley, Sarah, additional, Atkins, Bridget L., additional, Dudareva, Maria, additional, McNally, Martin A., additional, O’Grady, Justin, additional, Crook, Derrick W., additional, and Eyre, David W., additional

Published
2022
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92. General treatment principles for fracture-related infection: recommendations from an international expert group

Author

Metsemakers, Willem-Jan, Morgenstern, Mario, Senneville, Eric, Borens, Olivier, Govaert, Geertje AM, Onsea, Jolien, Depypere, Melissa, Richards, R Geoff, Trampuz, Andrej, Verhofstad, Michael HJ, Kates, Stephen L, Raschke, Michael, McNally, Martin A, Obremskey, William T, Athanasou, Nick, Atkins, Bridget L, Eckardt, Henrik, Egol, Kenneth A, Hungerer, Sven, Kuehl, Richard, Marais, Leonard, Mcfadyen, Ian, Foster, William, Fragomen, Austin T, Moriarty, T Fintan, Ochsner, Peter, Ramsden, Alex, Sancineto, Carlos, Zalavras, Charalampos, Zimmerli, Werner, and Surgery

Subjects
medicine.medical_specialty, Consensus, Standardization, ORTHOPEDIC-SURGERY, Periprosthetic, ANESTHESIOLOGISTS PHYSICAL STATUS, Implant removal, SURGICAL-SITE INFECTION, 03 medical and health sciences, Fracture Fixation, Internal, Fractures, Bone, HEALTH-CARE EPIDEMIOLOGY, 0302 clinical medicine, Fracture fixation, Diagnosis, Medicine, Humans, Surgical Wound Infection, COMPUTER ADAPTIVE TEST, Orthopedics and Sports Medicine, Sampling (medicine), 030212 general & internal medicine, POSTOPERATIVE COMPLICATIONS, Intensive care medicine, Outcome, 030222 orthopedics, Fracture-related infection, Science & Technology, business.industry, CHRONIC OSTEOMYELITIS, General Medicine, Evidence-based medicine, Bacterial Infections, Expert group, ANTIBIOTIC STEWARDSHIP, EXPOSED HARDWARE, Orthopaedic Surgery, Anti-Bacterial Agents, Treatment, Orthopedics, Fracture, HYPOVITAMINOSIS D, Orthopedic surgery, Practice Guidelines as Topic, Surgery, business, Infection, Life Sciences & Biomedicine
Abstract

Fracture-related infection (FRI) remains a challenging complication that creates a heavy burden for orthopaedic trauma patients, their families and treating physicians, as well as for healthcare systems. Standardization of the diagnosis of FRI has been poor, which made the undertaking and comparison of studies difficult. Recently, a consensus definition based on diagnostic criteria for FRI was published. As a well-established diagnosis is the first step in the treatment process of FRI, such a definition should not only improve the quality of published reports but also daily clinical practice. The FRI consensus group recently developed guidelines to standardize treatment pathways and outcome measures. At the center of these recommendations was the implementation of a multidisciplinary team (MDT) approach. If such a team is not available, it is recommended to refer complex cases to specialized centers where a MDT is available and physicians are experienced with the treatment of FRI. This should lead to appropriate use of antimicrobials and standardization of surgical strategies. Furthermore, an MDT could play an important role in host optimization. Overall two main surgical concepts are considered, based on the fact that fracture fixation devices primarily target fracture consolidation and can be removed after healing, in contrast to periprosthetic joint infection were the implant is permanent. The first concept consists of implant retention and the second consists of implant removal (healed fracture) or implant exchange (unhealed fracture). In both cases, deep tissue sampling for microbiological examination is mandatory. Key aspects of the surgical management of FRI are a thorough debridement, irrigation with normal saline, fracture stability, dead space management and adequate soft tissue coverage. The use of local antimicrobials needs to be strongly considered. In case of FRI, empiric broad-spectrum antibiotic therapy should be started after tissue sampling. Thereafter, this needs to be adapted according to culture results as soon as possible. Finally, a minimum follow-up of 12 months after cessation of therapy is recommended. Standardized patient outcome measures purely focusing on FRI are currently not available but the patient-reported outcomes measurement information system (PROMIS) seems to be the preferred tool to assess the patients' short and long-term outcome. This review summarizes the current general principles which should be considered during the whole treatment process of patients with FRI based on recommendations from the FRI Consensus Group.Level of evidence: Level V. ispartof: ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY vol:140 issue:8 pages:1013-1027 ispartof: location:Germany status: published

Published
2020
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93. Pre-Referral Microbiology in Long Bone Infection: What Can It Tell Us?

Author

Hotchen, Andrew J., Corrigan, Ruth A., Dudareva, Maria, Bernard, Andrew, Ferguson, Jamie, Atkins, Bridget L., and McNally, Martin

Subjects
MICROBIOLOGY, DEBRIDEMENT, BONE surgery, INFECTION
Abstract

Background: It remains unclear how accurately patients' previous microbiology correlates with that ascertained from deep sampling in long bone infection. This study assessed the quality of microbiology referral information and compared it to the gold standard of intra-operative deep tissue sampling. Methods: All patients referred to a single specialist centre within the UK between January 2019 and March 2020 who received surgery for long bone infection were eligible for inclusion. Data on microbiological testing that was performed prior to referral was collected prospectively at the time of clinic appointment and prior to surgery. Pre-referral microbiology was compared to microbiology from deep tissue samples taken during surgery. Results: 141 patients met the diagnostic criteria for long bone infection and were included for analysis. Of these, 72 patients had microbiological information available at referral from 88 samples, obtained from either sinus swab (n = 40), previous surgical sampling (n = 25), biopsy (n = 19) or blood cultures (n = 4). In 65.9% of samples, pre-referral microbiology was deemed to be a non-match when compared to intra-operative samples. Factors that increased risk of a non-match included presence of a sinus (odd's ratio (OR) 11.3 [95% CI 2.84–56.6], p = 0.001), increased duration of time from sampling (OR 2.29, [95% CI 1.23–5.90], p = 0.030) and results from prior surgical sampling (OR 23.0 [95% CI 2.80–525.6], p = 0.011). Furthermore, previous surgical debridement gave an increased risk of multi-, extensively or pan-resistant isolates cultured from intra-operative sampling (OR 3.6 [95% CI 1.5–8.7], p < 0.01). Conclusions: We have demonstrated that presence of a sinus, a long time from the sample being taken and results from prior surgical sampling are more likely to give inaccurate representation of current microbiology. Importantly, in cases with previous debridement surgery, there was an increased risk of multi drug resistant isolates which should be planned for in future treatments. [ABSTRACT FROM AUTHOR]

Published
2023
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96. Clinical Metagenomic Sequencing for Species Identification and Antimicrobial Resistance Prediction in Orthopaedic Device Infection

Author

Street, Teresa L., primary, Sanderson, Nicholas D., additional, Kolenda, Camille, additional, Kavanagh, James, additional, Pickford, Hayleah, additional, Hoosdally, Sarah, additional, Cregan, Jack, additional, Taunt, Carol, additional, Jones, Emma, additional, Oakley, Sarah, additional, Atkins, Bridget L., additional, Dudareva, Maria, additional, McNally, Martin A., additional, O’Grady, Justin, additional, Crook, Derrick W., additional, and Eyre, David W., additional

Published
2021
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