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Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_14 | Pages 57 - 57
1 Dec 2019
ANTIBIOTIC TREATMENT AND MICROBIOLOGICAL FINDINGS IN COMPLEX FRACTURE-RELATED INFECTIONS: A SYSTEMATIC LITERATURE REVIEW
Bezstarosti H van Lieshout E Voskamp L Croughs P Kortram K McNally M Metsemakers W Verhofstad M
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Aim

The aim of this systematic review was to determine all cultured bacteria, antibiotic strategies, and their outcome from literature describing treatment of FRI patients between 1990 and 2018.

Methods

A systematic literature search was performed on treatment and outcome of FRI. All studies in English that described surgical patient series for treatment of FRI were included, using Medline, Embase, Web of Science, Cochrane, and Google Scholar. Publications before 1990 and studies that did not describe FRI patient treatment or did not report original data (e.g., reviews or meta-analyses) were excluded. Study selection and data collection were done by two authors independently. Main collected parameters were preoperative cultures, use of local antibiotics, postoperative antibiotic protocol, cultured microorganisms, and overall outcome of treatment, i.e., eradication of infection and bony union, recurrence, amputations, revisional surgery, and number of complications. Dichotomous data were pooled using Medcalc, and weighted means were calculated for continuous data using Excel.

Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_14 | Pages 18 - 18
1 Dec 2019
ANTIMICROBIAL EFFECT OF CERAMENT-G® ON BACTERIAL ISOLATES, WITH VARIOUS LEVELS OF GENTAMICIN RESISTANCE, FOUND IN FRACTURE-RELATED INFECTION: AN IN VITRO STUDY
Bezstarosti H Croughs P van der Hurk M Kortram K van Lieshout E Verhofstad M
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Aim

Fracture-related infection (FRI) is a serious complication after trauma. More often resistant micro-organisms are cultured. Gentamicin covers a wide variety of causative agents for FRI. A bio-absorbable antibiotic carrier, Cerament-G®, combines dead space management with local release of gentamicin in a one-stage approach. The achieved tissue concentrations of locally applied antibiotics are 4–8 thousand times higher than after systemic administration. Does Cerament-G® have antimicrobial activity towards bacteria that are not susceptible to systemic gentamicin administration.

Method

The four most often cultured bacterial species found in FRI were used; Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Enterobacter cloacae. For each species, four different isolates were obtained, each with a different susceptibility for gentamicin. This susceptibility, expressed in the minimal inhibitory concentration (MIC), varied from completely susceptible (MIC 0,064 mg/L – 4mg/L), minimal resistance (4mg/L – 16mg/L), moderate resistance (8 mg/L – 96 mg/L) to high resistance (24 mg/L - >1024 mg/L), depending on each different organism. Antimicrobial activity of Cerament-G® was determent by a Kirby-Bauer test, according to the EUCAST disc protocol. Each test was done in five-fold for each of the 16 cultured isolates, four of each species. The zone of inhibition (ZOI), obtained by the test, was compared between each bacterial isolate and within each of the four separate species.

Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_17 | Pages 25 - 25
1 Dec 2018
MANAGEMENT OF CRITICAL-SIZED BONE DEFECTS IN THE TREATMENT OF FRACTURE-RELATED INFECTION: A SYSTEMATIC REVIEW AND POOLED ANALYSIS
Bezstarosti H Metsemakers W van Lieshout E Kortram K Voskamp L McNally M Verhofstad MHJ
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Aim

The aim of this systematic review was to determine the reported treatment strategies, their individual success rates, and other outcome parameters in the management of critical-sized bone defects in Fracture-Related Infection (FRI) patients between 1990 and 2018.

Method

We performed a systematic literature search on treatment and outcome of critical-sized bone defects in FRI. Treatment strategies identified were, autologous cancellous grafts, autologous cancellous grafts combined with local antibiotics, the induced membrane technique, vascularized grafts, bone transport, and bone transport combined with local antibiotics. Studies describing bone defects of 1 cm or greater were included. Outcomes were bone healing and infection eradication after primary surgical protocol and recurrence of FRI and amputations at the end of study period.

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