ArticleAntibiotics (Basel, Switzerland)2022
What Is the Most Effective Empirical Antibiotic Treatment for Early, Delayed, and Late Fracture-Related Infections?
Article in Antibiotics (Basel, Switzerland), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
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Who cites it
23 citing papers in PubMed, 37 citations in OpenAlex.
- [Perioperative antibiotic prophylaxis in trauma surgery and orthopedics].Unfallchirurgie (Heidelberg, Germany) · 2026Article
- Impact of Narrow Empiric Antibiotic Spectrum and Patient Characteristics on Clinical Outcomes in Bone and Joint Infections: A Retrospective Cohort Study.Antibiotics (Basel, Switzerland) · 2026Article
- Clinical Outcome After Surgery for Fracture-Related Infection Is Dependent on Both Microbiology and the Host Inflammatory Response.Pathogens (Basel, Switzerland) · 2026Article
- Staged Management of Bone Defects in Chronic Osteomyelitis and Nonunions Using Antibiotic-Loaded Calcium Sulphate-Hydroxyapatite: A Multicenter Retrospective Analysis of 101 Cases.Therapeutics and clinical risk management · 2026Article
- Is routine Gram-negative antibiotic coverage required for optimum antibiotic prophylaxis in open reduction and internal fixation of fractures? A multicenter analysis of bacteria pathogens in fracture-related infections.Musculoskeletal surgery · 2025Article
- Fracture-Related Infection of the Proximal Femur - Diagnostics and Treatment.Geriatric orthopaedic surgery & rehabilitation · 2025Review
- Metagenomic changes in response to antibiotic treatment in severe orthopedic trauma patients.iScience · 2024Article
- Time to Positivity in Blood Culture Bottles Inoculated with Sonication Fluid from Fracture-Related Infections.Microorganisms · 2024Article
- The Microbiological Profile and Antibiotic Susceptibility of Fracture Related Infections in a Low Resource Setting Differ from High Resource Settings: A Cohort Study from Cameroon.Antibiotics (Basel, Switzerland) · 2024Article
- Infection with multi‑drug resistant organisms in patients with limb fractures: Analysis of risk factors and pathogens.Biomedical reports · 2024Article
- Fracture-Related Infection-Epidemiology, Etiology, Diagnosis, Prevention, and Treatment.Deutsches Arzteblatt international · 2024Review
- Aetiology of long bone chronic osteomyelitis: an analysis of the current situation in one region in Egypt.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2023Article
- Treatment of Fracture-Related Infections with Bone Abscess Formation after K-Wire Fixation of Pediatric Distal Radius Fractures in Adolescents-A Report of Two Clinical Cases.Children (Basel, Switzerland) · 2023Article
- Comparative analysis of pathogen distribution in patients with fracture-related infection and periprosthetic joint infection: a retrospective study.BMC musculoskeletal disorders · 2023Article
- Antibiotic-Loaded Coatings to Reduce Fracture-Related Infections: Retrospective Case Series of Patients with Increased Infectious Risk.Antibiotics (Basel, Switzerland) · 2023Article
- Multidisciplinary Treatment of Fracture-Related Infection Has a Positive Impact on Clinical Outcome-A Retrospective Case Control Study at a Tertiary Referral Center.Antibiotics (Basel, Switzerland) · 2023Article
- Pre-Referral Microbiology in Long Bone Infection: What Can It Tell Us?Antibiotics (Basel, Switzerland) · 2022Article
- The Prognostic Utility of Lymphocyte-Based Measures and Ratios in Chemotherapy-Induced Febrile Neutropenia Patients following Granulocyte Colony-Stimulating Factor Therapy.Medicina (Kaunas, Lithuania) · 2022Article
- The State of Research in Fracture-Related Infection-A Bibliometric Analysis.Medicina (Kaunas, Lithuania) · 2022Review
- Evaluation of Comorbidities as Risk Factors for Fracture-Related Infection and Periprosthetic Joint Infection in Germany.Journal of clinical medicine · 2022Article
Corrections and comments
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
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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