Epidemiological updates of post-traumatic related limb osteomyelitis in china: a 10 years multicentre cohort study

作者：Ren, YouLiang; Liu, Lei; Sun, Dong; Zhang, ZhengDong; Li, Meng; Lan, Xu; Ni, JiangDong; Yan, Ming-Ming; Huang, Wei; Liu, Zi-Ming; Peng, AQin; Zhang, YanLong; Jiang, Nan; Song, KeGuan; Huang, ZhiPeng; Bi, Qing; Zhang, Jun; Yang, Qun; Yang, Jun; Liu, Yi; Fu, Wei; Tian, XiaoBin; Wang, YuanZheng; Zhong, WanRun; Song, XingHua; Abudurexiti, Abuduxukuer; Xia, ZhiLin; Jiang, Qing; Shi, HongFei; Liu, XiMing; Wang, GuoDong; Hu, YunSheng; Zhang, YunFei; Yin, GuoYong; Fan, Jin; Feng, ShiQing; Zhou, XianHu

来源：International Journal of Surgery, 2023, 109(9): 2721-2731.

DOI：10.1097/JS9.0000000000000502

• multiple-centre
• osteomyelitis
• post-traumatic related limb
• risk factors
• staphylococcus aureus

Background: Post-traumatic related limb osteomyelitis (PTRLO) is a complex bone infection. Currently, there are no available microbial data on a national scale that can guide appropriate antibiotic selection, and explore the dynamic changes in dominant pathogens over time. This study aimed to conduct a comprehensive epidemiological analysis of PTRLO in China. @@@ Methods: The study was approved by the Institutional Research Board (IRB), and 3526 PTRLO patients were identified from 212 394 traumatic limb fracture patients at 21 hospitals between 1 January 2008 and 31 December 2017. A retrospective analysis was conducted to investigate the epidemiology of PTRLO, including changes in infection rate (IR), pathogens, infection risk factors and antibiotic resistance and sensitivity. @@@ Results: The IR of PTRLO increased gradually from 0.93 to 2.16% (Z=14.392, P<0.001). Monomicrobial infection (82.6%) was significantly higher than polymicrobial infection (17.4%) (P<0.001). The IR of Gram-positive (GP) and Gram-negative (GN) pathogens showed a significant increase from the lowest 0.41% to the highest 1.15% (GP) or 1.62% (GN), respectively. However, the longitudinal trend of GP vs. GN's composition did not show any significance (Z=1.1918, P>0.05). The most prevalent GP strains were Methicillin-sensitive Staphylococcus aureus (MSSA) (17.03%), Methicillin-resistant Staphylococcus aureus (MRSA) (10.46%), E. faecalis (5.19%) and S. epidermidis (4.87%). In contrast, the dominant strains GN strains were Pseudomonas Aeruginosa (10.92%), E. cloacae (10.34%), E. coli (9.47%), Acinetobacter Baumannii (7.92%) and Klebsiella Pneumoniae (3.33%). In general, the high-risk factors for polymicrobial infection include opened-fracture (odds ratio, 2.223), hypoproteinemia (odds ratio, 2.328), and multiple fractures (odds ratio, 1.465). It is important to note that the antibiotics resistance and sensitivity analysis of the pathogens may be influenced by complications or comorbidities. @@@ Conclusions: This study provides the latest data of PTRLO in China and offers trustworthy guidelines for clinical practice. (China Clinical Trials.gov number, ChiCTR1800017597).

• 单位
  河北医科大学; 中国人民解放军第四军医大学; 1; 中山大学; 上海交通大学; 同济大学; 6; 南京大学; 哈尔滨医科大学; 北京大学; 南方医科大学; 四川大学