Journal Article

Factors influencing treatment success of negative pressure wound therapy in patients with postoperative infections after Osteosynthetic fracture fixation

Hansen, Stephanie, Schmal, Hagen, Südkamp, Norbert P, Izadpanah, Kaywan, Six-Merker, Julia, Helwig, Peter

2017

Overview

Background Negative Pressure Wound Therapy (NPWT) is being increasingly used to treat postoperative infections after osteosynthetic fracture fixation. The aim of the present study was to analyze the influence of epidemiological and microbiological parameters on outcome. Methods Infections following operative fracture fixation were registered in a comprehensive Critical Incidence Reporting System and subsequently analyzed retrospectively for characteristics of patients including comorbidity, bacteria, and clinical factors. The influence of the investigated parameters was analyzed using logistic regression models based on data from 106 patients. Results Staged wound lavage in combination with NPWT allowed implant preservation in 44% and led to successful healing in 73% of patients. Fermentation characteristics, load and behavior after gram staining revealed no statistically significant correlation with either healing or implant preservation. Infecting bacteria were successfully isolated in 87% of patients. 20% of all infections were caused by bacterial combinations. We observed a change in the infecting bacterial species under therapy in 23%. Age, gender, metabolic diseases or comorbidities did not influence the probability of implant preservation or healing. The delayed manifestation of infection (>4 weeks) correlated with a higher risk for implant loss (OR 5.1 [95% CI 1.41–17.92]) as did the presence of bacterial mixture (OR 5.0 [95% CI 1.41–17.92]) and open soft-tissue damage ≥ grade 3 (OR 10.2 [CI 1.88–55.28]). Wounds were less likely to heal in conjunction with high CRP blood levels (>20 mg/l) at the time of discharge (OR 3.6 [95% CI 1.31–10.08]) or following a change of the infecting bacterial species under therapy (OR 3.2 [95% CI, 1.13–8.99]). Conclusions These results indicate that the delayed manifestation of infection, high CRP blood levels at discharge, and alterations in the infecting bacterial species under therapy raise the risk of NPWT failure.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Aged / Amputation / Analysis / Antibiotics / Bacteria / Blood levels / Care and treatment / Clinical trial / Complications and side effects / Documentation / Epidemiology / Female / Fermentation / Fracture Fixation, Internal - adverse effects / Fracture Fixation, Internal - trends / Humans / Infection / Infections / Injuries / Internal fixation / Internal Medicine / ISO standards / Joint surgery / Logistic regression models / Male / Medicine / Medicine & Public Health / Metabolic disorders / Middle Aged / Musculoskeletal diseases / Negative-Pressure Wound Therapy - methods / Negative-Pressure Wound Therapy - trends / Npwt / Orthopedics / Osteosynthesis / Pathophysiology of musculoskeletal disorders / Patients / Preservation / Pressure / Regression analysis / Rehabilitation / Research Article / Retrospective Studies / Rheumatology / Risk Factors / Skin / Species / Sports Medicine / Statistical analysis / Surgical Wound Infection - diagnosis / Surgical Wound Infection - etiology / Surgical Wound Infection - therapy / Transplants & implants / Trauma / Treatment Outcome / Vac / Wound healing / Wounds