Multisite Study of the Management of Musculoskeletal Infection After Trauma: The MMUSKIT Study.

Autor: Seidelman J; Division of Infectious Diseases and International Health, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, USA., Ritter AS; Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA., Poehlein E; Department of Biostatistics and Bioinformatics, School of Medicine, Duke University, Durham, North Carolina, USA., Green CL; Department of Biostatistics and Bioinformatics, School of Medicine, Duke University, Durham, North Carolina, USA., Briggs DV; School of Medicine, Duke University, Durham, North Carolina, USA., Chari T; School of Medicine, Duke University, Durham, North Carolina, USA., Therien AD; School of Medicine, Duke University, Durham, North Carolina, USA., Aitchison AH; School of Medicine, Duke University, Durham, North Carolina, USA., Lunn K; School of Medicine, Duke University, Durham, North Carolina, USA., Zirbes CF; School of Medicine, Duke University, Durham, North Carolina, USA., Manohar T; Division of Infectious Diseases and Global Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA., Rijo DV; Department of Orthopedics and Sports Medicine, University of Florida, Gainesville, Florida, USA., Hagen JE; Department of Orthopedics and Sports Medicine, University of Florida, Gainesville, Florida, USA., Talerico MT; Department of Orthopedics and Sports Medicine, University of Florida, Gainesville, Florida, USA., DeBaun MR; Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA., Pean CA; Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA., Certain L; Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, USA., Nelson SB; Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2024 May 06; Vol. 11 (6), pp. ofae262. Date of Electronic Publication: 2024 May 06 (Print Publication: 2024).
DOI: 10.1093/ofid/ofae262
Abstrakt: Background: The optimal duration and choice of antibiotic for fracture-related infection (FRI) is not well defined. This study aimed to determine whether antibiotic duration (≤6 vs >6 weeks) is associated with infection- and surgery-free survival. The secondary aim was to ascertain risk factors associated with surgery- and infection-free survival.
Methods: We performed a multicenter retrospective study of patients diagnosed with FRI between 2013 and 2022. The association between antibiotic duration and surgery- and infection-free survival was assessed by Cox proportional hazard models. Models were weighted by the inverse of the propensity score, calculated with a priori variables of hardware removal; infection due to Staphylococcus aureus , Staphylococcus lugdunensis , Pseudomonas or Candida species; and flap coverage. Multivariable Cox proportional hazard models were run with additional covariates including initial pathogen, need for flap, and hardware removal.
Results: Of 96 patients, 54 (56.3%) received ≤6 weeks of antibiotics and 42 (43.7%) received >6 weeks. There was no association between longer antibiotic duration and surgery-free survival (hazard ratio [HR], 0.95; 95% CI, .65-1.38; P = .78) or infection-free survival (HR, 0.77; 95% CI, .30-1.96; P = .58). Negative culture was associated with increased hazard of reoperation or death (HR, 3.52; 95% CI, 1.99-6.20; P < .001) and reinfection or death (HR, 3.71; 95% CI, 1.24-11.09; P < .001). Need for flap coverage had an increased hazard of reoperation or death (HR, 3.24; 95% CI, 1.61-6.54; P = .001).
Conclusions: The ideal duration of antibiotics to treat FRI is unclear. In this multicenter study, there was no association between antibiotic treatment duration and surgery- or infection-free survival.
Competing Interests: Potential conflicts of interest. J. L. S. receives royalties from UptoDate as a content expert for pelvic osteomyelitis; received support for attending the IDWeek 2023 meeting to speak about prosthetic joint infection; and has been compensated as an expert witness for 3M, Woods Rogers Vandevenier Black PLC, Frith & Ellerman Law Firm, and Ross Feller & Casey for litigation related to prosthetic joint infection. A. S. R. declares a grant from the National Institutes of Health National Institute on Alcohol Abuse and Alcoholism (project 1UH2AA026214-01) and personal fees from DynaMed Plus as a topic editor. M. R. D. receives stock or stock options from Azra Care, NSite, Reselute; receives intellectual property royalties from Osteocentric, Reselute, Shukla, and UptoDate; is a paid consultant for Synthes, Next Science, Resulute, Shukla, and SI Bone; has research support from DePuy, a Johnson & Johnson Company; and is a board or committee member for the Orthopaedic Trauma Association. L. C. received support for this manuscript from the University of Utah, Department of Orthopaedics; received payment for expert testimony by Horn, Aylward, and Brandy for medical malpractice cases involving infected fracture fixation; and serves as a board member for the Musculoskeletal Infection Society. S. B. N. receives royalties from UptoDate for bone and joint infection and skin and soft tissue infection topics; received payment for the Infectious Diseases Board Review Course (George Washington CME); received support for attending the IDWeek 2023 meeting to speak on antibiotic suppression in prosthetic joint infections; is a member of the education committee for the Musculoskeletal Infection Society; and received stock options for Sonoran Biosciences in 2018. All other authors report no potential conflicts.
(© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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