Epidemiology and Outcomes of Infected Non-Unions: An Observational Study at an Infectious Disease Referral Centre
<b>Objectives</b>: The main aim of this study was to describe the epidemiology of infected non-unions (INUs) managed at an Infectious Disease (ID) referral centre and to investigate the factors associated with treatment failure. <b>Methods</b>: This was an observational retro...
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2024-12-01
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| author | Sara Tedeschi Nicolò Rossi Eleonora Zamparini Simone Ambretti Massimiliano Mosca Cesare Faldini Stefano Zaffagnini Alessandra Maso Andrea Sambri Massimiliano De Paolis Pierluigi Viale |
| author_facet | Sara Tedeschi Nicolò Rossi Eleonora Zamparini Simone Ambretti Massimiliano Mosca Cesare Faldini Stefano Zaffagnini Alessandra Maso Andrea Sambri Massimiliano De Paolis Pierluigi Viale |
| author_sort | Sara Tedeschi |
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| description | <b>Objectives</b>: The main aim of this study was to describe the epidemiology of infected non-unions (INUs) managed at an Infectious Disease (ID) referral centre and to investigate the factors associated with treatment failure. <b>Methods</b>: This was an observational retrospective study on adult patients with INUs managed between 2012 and 2018 at the ID Unit of the IRCCS Azienda Ospedaliero-Universitaria di Bologna, an Italian ID referral centre for bone and joint infections. Patients were observed for at least 24 months. Those who achieved clinical success were compared with those who experienced clinical failure; to identify factors associated with treatment failure, we performed a univariate and multivariate logistic regression analysis. <b>Results</b>: Overall, 78 patients were included. A total of 57/78 (73%) were males; their median age was 43 (IQR 34–56) years; their median Charlson index was 0 (IQR 0–2); 32/78 (41%) reported a history of an open fracture; the non-union most frequently involved the leg. Polymicrobial infection was found in 23/78 cases (29%); the most common microorganisms were coagulase-negative staphylococci (n = 47) and <i>Staphylococcus aureus</i> (n = 35). At 24-month follow-up from index surgery, 16/78 patients had experienced clinical failure: 13 (16.6%) presented with persistence of local signs of infection and 3 (3.8%) had undergone amputation. Logistic regression analysis of risk factors for clinical failure identified body mass index (BMI) (aOR 1.15; 95% CI 1.03–1.28, <i>p</i> = 0.01) and MRSA infection (aOR 5.35; 95% CI 1.06–26.92, <i>p</i> = 0.04) as factors associated with clinical failure. <b>Conclusions</b>: Given that a standardized management of antibiotic therapy is initiated by an expert ID consultant team, BMI and MRSA infection are associated with worse outcomes among patients with INUs. |
| format | Article |
| id | doaj-art-cdc787c1c25f4d2b99ca7791a870452e |
| institution | OA Journals |
| issn | 2079-6382 |
| language | English |
| publishDate | 2024-12-01 |
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| series | Antibiotics |
| spelling | doaj-art-cdc787c1c25f4d2b99ca7791a870452e2025-08-20T02:01:05ZengMDPI AGAntibiotics2079-63822024-12-011312118010.3390/antibiotics13121180Epidemiology and Outcomes of Infected Non-Unions: An Observational Study at an Infectious Disease Referral CentreSara Tedeschi0Nicolò Rossi1Eleonora Zamparini2Simone Ambretti3Massimiliano Mosca4Cesare Faldini5Stefano Zaffagnini6Alessandra Maso7Andrea Sambri8Massimiliano De Paolis9Pierluigi Viale10Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, ItalyDepartment of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, ItalyInfectious Diseases Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyDepartment of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, ItalyUO Ortopedia Bentivoglio, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, ItalyI Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, ItalyDepartment of Biomedical and Neuromotor Science-DIBINEM, Alma Mater Studiorum University of Bologna, 40126 Bologna, ItalyLaboratory of Microbiology and GMP Quality Control, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, ItalyOrthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyOrthopaedics and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyDepartment of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy<b>Objectives</b>: The main aim of this study was to describe the epidemiology of infected non-unions (INUs) managed at an Infectious Disease (ID) referral centre and to investigate the factors associated with treatment failure. <b>Methods</b>: This was an observational retrospective study on adult patients with INUs managed between 2012 and 2018 at the ID Unit of the IRCCS Azienda Ospedaliero-Universitaria di Bologna, an Italian ID referral centre for bone and joint infections. Patients were observed for at least 24 months. Those who achieved clinical success were compared with those who experienced clinical failure; to identify factors associated with treatment failure, we performed a univariate and multivariate logistic regression analysis. <b>Results</b>: Overall, 78 patients were included. A total of 57/78 (73%) were males; their median age was 43 (IQR 34–56) years; their median Charlson index was 0 (IQR 0–2); 32/78 (41%) reported a history of an open fracture; the non-union most frequently involved the leg. Polymicrobial infection was found in 23/78 cases (29%); the most common microorganisms were coagulase-negative staphylococci (n = 47) and <i>Staphylococcus aureus</i> (n = 35). At 24-month follow-up from index surgery, 16/78 patients had experienced clinical failure: 13 (16.6%) presented with persistence of local signs of infection and 3 (3.8%) had undergone amputation. Logistic regression analysis of risk factors for clinical failure identified body mass index (BMI) (aOR 1.15; 95% CI 1.03–1.28, <i>p</i> = 0.01) and MRSA infection (aOR 5.35; 95% CI 1.06–26.92, <i>p</i> = 0.04) as factors associated with clinical failure. <b>Conclusions</b>: Given that a standardized management of antibiotic therapy is initiated by an expert ID consultant team, BMI and MRSA infection are associated with worse outcomes among patients with INUs.https://www.mdpi.com/2079-6382/13/12/1180infectednon-unionpseudoarthrosis |
| spellingShingle | Sara Tedeschi Nicolò Rossi Eleonora Zamparini Simone Ambretti Massimiliano Mosca Cesare Faldini Stefano Zaffagnini Alessandra Maso Andrea Sambri Massimiliano De Paolis Pierluigi Viale Epidemiology and Outcomes of Infected Non-Unions: An Observational Study at an Infectious Disease Referral Centre Antibiotics infected non-union pseudoarthrosis |
| title | Epidemiology and Outcomes of Infected Non-Unions: An Observational Study at an Infectious Disease Referral Centre |
| title_full | Epidemiology and Outcomes of Infected Non-Unions: An Observational Study at an Infectious Disease Referral Centre |
| title_fullStr | Epidemiology and Outcomes of Infected Non-Unions: An Observational Study at an Infectious Disease Referral Centre |
| title_full_unstemmed | Epidemiology and Outcomes of Infected Non-Unions: An Observational Study at an Infectious Disease Referral Centre |
| title_short | Epidemiology and Outcomes of Infected Non-Unions: An Observational Study at an Infectious Disease Referral Centre |
| title_sort | epidemiology and outcomes of infected non unions an observational study at an infectious disease referral centre |
| topic | infected non-union pseudoarthrosis |
| url | https://www.mdpi.com/2079-6382/13/12/1180 |
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