Long-term patient-related quality of life after fracture-related infections of the long bones

Walter, Nike; Rupp, Markus; Hierl, Katja; Pfeifer, Christian; Kerschbaum, Maximilian; Hinterberger, Thilo; Alt, Volker

doi:10.1302/2046-3758.105.bjr-2020-0532

Cited by 42 publications

(29 citation statements)

References 36 publications

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“…Success rates only vary between 70-90% with a recurrence of the disease in 6-9% of the patients. Several limitations, such as immobility up to amputations of the affected limb, prolonged length of stay in hospital, multiple surgeries, side effects of antibiotic medication, and further socioeconomic issues, are often not to be avoided despite a variety of treatment concepts [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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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Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…3,4 To reduce costs and improve fracture care in these cases, novel therapies to promote fracture healing need to be developed. 5 Fracture healing is influenced by many factors, including age, smoking, concomitant diseases, and the energy of the injury. [6][7][8][9] Chronic and heavy alcohol consumption can disturb the bone homeostasis, which may eventually lead to an increased likelihood of fracture nonunion or delayed union.…”

Section: Introductionmentioning

confidence: 99%

Alcohol-induced inhibition of bone formation and neovascularization contributes to the failure of fracture healing via the miR-19a-3p/FOXF2 axis

Zhu

Fang

et al. 2022

Bone & Joint Research

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Aims Alcoholism is a well-known detrimental factor in fracture healing. However, the underlying mechanism of alcohol-inhibited fracture healing remains poorly understood. Methods MicroRNA (miR) sequencing was performed on bone mesenchymal stem cells (BMSCs). The effects of alcohol and miR-19a-3p on vascularization and osteogenic differentiation were analyzed in vitro using BMSCs and human umbilical vein endothelial cells (HUVECs). An in vivo alcohol-fed mouse model of femur fracture healing was also established, and radiological and histomorphometric analyses were used to evaluate the role of miR-19a-3p. The binding of miR-19a-3p to forkhead box F2 (FOXF2) was analyzed using a luciferase reporter assay. Results miR-19a-3p was identified as one of the key regulators in the osteogenic differentiation of BMSCs, and was found to be downregulated in the alcohol-fed mouse model of fracture healing. In vitro, miR-19a-3p expression was downregulated after ethanol administration in both BMSCs and HUVECs. Vascularization and osteogenic differentiation were independently suppressed by ethanol and reversed by miR-19a-3p. In addition, the luciferase reporter assay showed that FOXF2 is the direct binding target of miR-19a-3p. In vivo, miR-19a-3p agomir stimulated callus transformation and improved the alcohol-impaired fracture healing. Conclusion This study is the first to demonstrate that the miR-19a-3p/FOXF2 axis has a pivotal role in alcohol-impaired fracture healing, and may be a potential therapeutic target. Cite this article: Bone Joint Res 2022;11(6):386–397.

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“…The average utility after hip fracture varies from 0.379 at 4 months to 0.67 at 24 months (Polinder et al, 2007;Sims et al, 2018). The minimum clinical important difference is 0.08 (Walters and Brazier, 2005).…”

Section: Introductionmentioning

confidence: 99%

Mortality, functional outcomes and quality of life after hip fractures complicated by infection: a case control study

Koutalos

Baltas

Akrivos

et al. 2021

J. Bone Joint Infect.

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Abstract. Introduction: Infection is a detrimental complication of operatively treated hip fractures. The objective of this retrospective case-control study was to evaluate the mortality, the physical function and the quality of life of hip fractures complicated with infection and determine risk factors for deep infection in hip fractures. Patients and methods: All patients with hip fractures (31A and 31B OTA/AO) that were operatively managed over a 10-year period that subsequently developed deep infection were included in the study. Thirty-nine patients met the inclusion criteria. These patients were compared with a matched control group of 198 patients without infection. Minimum follow-up was 1 year. Mortality, Barthel index score, EQ-5D-5L, Parker mobility score and visual analogue scale (VAS) pain score were compared between groups. Results: Mortality at 1 month was 20.5 % and 43 % at 1 year. Half of the infections were acute and 28 % were polymicrobial. Mortality was greater in the infection group (43 % vs. 16.5 %, p<0.0014), and Barthel index was inferior in the infection group (14 vs. 18, p<0.0017) compared to control group. Logistic regression analysis revealed that time from admission to surgery was a negative factor that predisposed to infection. Conclusions: Patients complicated with infection after a hip fracture have higher mortality and inferior functional results. Delay from admission to surgery predisposes to infection.

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Long-term patient-related quality of life after fracture-related infections of the long bones

Cited by 42 publications

References 36 publications

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

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

Alcohol-induced inhibition of bone formation and neovascularization contributes to the failure of fracture healing via the miR-19a-3p/FOXF2 axis

Mortality, functional outcomes and quality of life after hip fractures complicated by infection: a case control study

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