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7. 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

8. Key aspects of soft tissue management in fracture-related infection: recommendations from an international expert group.

Author

Marais, Leonard C., Hungerer, Sven, Eckardt, Henrik, Zalavras, Charalampos, Obremskey, William T., Ramsden, Alex, McNally, Martin A., Morgenstern, Mario, Metsemakers, Willem-Jan, Atkins, Bridget L., Borens, Olivier, Depypere, Melissa, Egol, Kenneth A., Fragomen, Austin T., Onsea, Jolien, Govaert, Geertje A. M., Kates, Stephen L., Kuehl, Richard, Mcfadyen, Ian, and Fintan Moriarty, T.

Subjects
NEGATIVE-pressure wound therapy, MICROBIAL cultures, SURGICAL site
Abstract

A judicious, well-planned bone and soft tissue debridement remains one of the cornerstones of state-of-the-art treatment of fracture-related infection (FRI). Meticulous surgical excision of all non-viable tissue can, however, lead to the creation of large soft tissue defects. The management of these defects is complex and numerous factors need to be considered when selecting the most appropriate approach. This narrative review summarizes the current evidence with respect to soft tissue management in patients diagnosed with FRI. Specifically we discuss the optimal timing for tissue closure following debridement in cases of FRI, the need for negative microbiological culture results from the surgical site as a prerequisite for definitive wound closure, the optimal type of flap in case of large soft tissue defects caused by FRI and the role of negative pressure wound therapy (NPWT) in FRI. Finally, recommendations are made with regard to soft tissue management in FRI that should be useful for clinicians in daily clinical practice. Level of evidence Level V. [ABSTRACT FROM AUTHOR]

Published
2024
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15. 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

16. 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

17. 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

18. 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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19. 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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20. 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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21. 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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29. 7: Soft tissue, bone and joint infections

Author

Gottlieb, Thomas, Atkins, Bridget L., and Shaw, David R.

Subjects
Arthritis, Infectious -- Care and treatment, Arthritis, Infectious -- Diagnosis, Infectious arthritis, Joint diseases -- Care and treatment, Joint diseases -- Diagnosis, Bone diseases -- Diagnosis, Bone diseases -- Care and treatment, Health
Abstract

Infections of soft tissue, bones, and joints can be lethal if not recognized and treated quickly. Diagnosis and treatment methods are presented for several types of infections including septic arthritis, prosthetic joint infection, and osteomyelitis.

Published
2002

34. Oral versus Intravenous Antibiotics for Bone and Joint Infection

Author

Li, Ho-Kwong, primary, Rombach, Ines, additional, Zambellas, Rhea, additional, Walker, A. Sarah, additional, McNally, Martin A., additional, Atkins, Bridget L., additional, Lipsky, Benjamin A., additional, Hughes, Harriet C., additional, Bose, Deepa, additional, Kümin, Michelle, additional, Scarborough, Claire, additional, Matthews, Philippa C., additional, Brent, Andrew J., additional, Lomas, Jose, additional, Gundle, Roger, additional, Rogers, Mark, additional, Taylor, Adrian, additional, Angus, Brian, additional, Byren, Ivor, additional, Berendt, Anthony R., additional, Warren, Simon, additional, Fitzgerald, Fiona E., additional, Mack, Damien J.F., additional, Hopkins, Susan, additional, Folb, Jonathan, additional, Reynolds, Helen E., additional, Moore, Elinor, additional, Marshall, Jocelyn, additional, Jenkins, Neil, additional, Moran, Christopher E., additional, Woodhouse, Andrew F., additional, Stafford, Samantha, additional, Seaton, R. Andrew, additional, Vallance, Claire, additional, Hemsley, Carolyn J., additional, Bisnauthsing, Karen, additional, Sandoe, Jonathan A.T., additional, Aggarwal, Ila, additional, Ellis, Simon C., additional, Bunn, Deborah J., additional, Sutherland, Rebecca K., additional, Barlow, Gavin, additional, Cooper, Cushla, additional, Geue, Claudia, additional, McMeekin, Nicola, additional, Briggs, Andrew H., additional, Sendi, Parham, additional, Khatamzas, Elham, additional, Wangrangsimakul, Tri, additional, Wong, T.H. Nicholas, additional, Barrett, Lucinda K., additional, Alvand, Abtin, additional, Old, C. Fraser, additional, Bostock, Jennifer, additional, Paul, John, additional, Cooke, Graham, additional, Thwaites, Guy E., additional, Bejon, Philip, additional, and Scarborough, Matthew, additional

Published
2019
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35. Cat scratch disease diagnosed by polymerase chain reaction in a patient with suspected tuberculous lymphadenitis

Author

Gottlieb, Tom, Atkins, Bridget L., and Robson, Jenny M.B.

Subjects
Cat-scratch disease -- Diagnosis, Lymphadenitis -- Diagnosis, Health
Abstract

Cat scratch disease (CSD) may closely mimic the symptoms of tuberculous lymphadenitis. A 36-year-old woman developed a painful mass on her upper chest. After removal of the mass and diagnostic testing, she was referred for treatment for probable tuberculosis. Blood tests for Bartonella henselae, the causative organism in CSD, had been negative, but infection with Bartonella was confirmed by polymerase chain reaction testing.

Published
1999

37. Molecular Diagnosis of Orthopedic-Device-Related Infection Directly from Sonication Fluid by Metagenomic Sequencing

Author

Street, Teresa L., primary, Sanderson, Nicholas D., additional, Atkins, Bridget L., additional, Brent, Andrew J., additional, Cole, Kevin, additional, Foster, Dona, additional, McNally, Martin A., additional, Oakley, Sarah, additional, Peto, Leon, additional, Taylor, Adrian, additional, Peto, Tim E. A., additional, Crook, Derrick W., additional, and Eyre, David W., additional

Published
2017
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38. Molecular diagnosis of orthopaedic device infection direct from sonication fluid by metagenomic sequencing

Author

Street, Teresa L., primary, Sanderson, Nicholas D., additional, Atkins, Bridget L., additional, Brent, Andrew J., additional, Cole, Kevin, additional, Foster, Dona, additional, McNally, Martin A., additional, Oakley, Sarah, additional, Peto, Leon, additional, Taylor, Adrian, additional, Peto, Tim E.A., additional, Crook, Derrick W., additional, and Eyre, David W., additional

Published
2017
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47. Rapid and cost-effective identification of Candidaspecies using multipoint inoculation of CHROMagar Candida media, cycloheximide sensitivity and carbohydrate assimilation tests

Author

Tambosis, Evanthia, Capizzi, Terri, Gottlieb, Thomas, and Atkins, Bridget L.

Abstract

Increasing numbers of nosocomial infections with Candidaspecies are caused by species other than Candida albicans.Definitive identification of Candidaspp. usually utilises one commercial biochemical identification strip per isolate. As an alternative, CHROMagar Candida (CHROMagar, France) can be used to differentiate some species but lacks accuracy for some species, and is expensive when used as a primary isolation medium. The aim of this study was to evaluate a multipoint inoculation method for batch identification of Candidaisolates, by generating a unique profile using CHROMagar Candida, a cycloheximide-containing medium and media containing seven in-house prepared carbohydrates.

Published
2003
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48. Cost-effectiveness of oral versus intravenous antibiotics (OVIVA) in patients with bone and joint infection: evidence from a non-inferiority trial.

Author

McMeekin N, Geue C, Briggs A, Rombach I, Li HK, Bejon P, McNally M, Atkins BL, Ferguson J, and Scarborough M

Abstract

Background:  Bone and joint infections are becoming increasingly common and are usually treated with surgery and a course of intravenous antibiotics. However, there is no evidence to support the superiority of intravenous therapy and there is a growing body of literature showing that oral therapy is effective in treating these infections.Given this lack of evidence the clinical trial 'Oral Versus Intravenous Antibiotics' (OVIVA) was designed to assess the clinical and cost-effectiveness of intravenous versus oral antibiotics for the treatment of bone and joint infections, using a non-inferiority design. Clinical results from the trial indicate that oral antibiotics are non-inferior to intravenous antibiotics. The aim of this paper is to evaluate the cost-effectiveness of intravenous compared to oral antibiotics for treating bone and joint infections, using data from OVIVA. Methods:  A cost-utility analysis was carried out, the main economic outcome measure was the quality adjusted life-year, measured using the EQ-5D-3L questionnaire, combined with costs to estimate cost-effectiveness over 12-months follow-up. Results:  Results show that costs were significantly lower in the oral arm compared to the intravenous arm, a difference of £2,740 (95% confidence interval £1,488 to £3,992). Results of four sensitivity analyses were consistent with the base-case results. QALYs were marginally higher in the oral arm, however this difference was not statistically significant; -0.007 (95% confidence interval -0.045 to 0.031). Conclusions:  Treating patients with bone and joint infections for the first six weeks of therapy with oral antibiotics is both less costly and does not result in detectable differences in quality of life compared to treatment with intravenous antibiotics. Adopting a practice of treating bone and joint infections with oral antibiotics early in the course of therapy could potentially save the UK National Health Service over £17 million annually., Competing Interests: No competing interests were disclosed., (Copyright: © 2019 McMeekin N et al.)

Published
2019
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