Preliminary Analysis Of Risk Factors For Recurrence Of Bone Infection

Purpose:Bone-related infections have always been a common disease of orthopaedics.The recurrence of infections will bring heavy burden to patients themselves and their families.Although it is well known that open fracture is an important cause of infection.The definition of fracture-related infections was not agreed until December 2016 at the Swiss expert meeting.Several diagnostic or indicative criteria were mentioned in the consensus.However,there is no data to confirm these standards.For the recurrence of fracture-related infections and the subsequent conditions such as chronic osteomyelitis and infectious nonunion,clinicians often can only treat symptoms.The purpose of this study is to analyze the patient’s case data and to identify risk factors for recurrence of infection from the diagnostic criteria mentioned in the consensus on fracture-related infections.Methods:This study is a retrospective case collection and analysis.Risk factors were identified by collecting bone infection-related patients hospitalized in Nanjing General Hospital of Nanjing Military Command,PLA from April 2015 to April 2019.Firstly,the results of bacterial culture were analyzed,and the distribution proportion of pathogenic bacteria of bone infection in the past five years was obtained.336 patients with surgical treatment were further screened out from 357 patients.The recurrence rate was analyzed by chi-square test and significant difference test.From the general age,gender,lesion location,and the selected criteria in accordance with the FRI consensus,whether these criteria are the risk factors of infection was comprehensively analyzed.Further use of multivariate logistic regression model to discuss and identify the factors that have significant differences,further analysis,identify and analyze the risk factors,and provide preventive measures.Results:Staphylococcus aureus was the most important pathogen in the past five years,followed by Pseudomonas aeruginosa,and the ratio of positive to negative bacteria was almost the same in Gram staining.In general,due to the disparity in the proportion of men and women in the patients collected in this study,the reference value of sex is not significant.Considering the sampling error,previous literature generally considered that the elderly was a risk factor.However,in this experiment,although the recurrence rate of the elderly patients was large,its p value was>0.05.The recurrence rate of traumatic patients was significantly higher than that of non-traumatic patients(p=0.011).Among them,the recurrence rate of fracture seen by imaging at admission was higher than that without fracture(p=0.039).The recurrence rate of nonunion was higher in patients with nonunion than in patients without nonunion(p=0.041).Patients with periosteal reaction or hyperosteogeny had a higher recurrence rate than those without it(p=0.045).Three diagnostic criteria were selected:Sinus tract,fistula or wound dehiscence,purulent or persistent exudation,and deep hematocele and pyometra.There was no significant difference in the recurrence rate when the three criteria were considered separately.The recurrence rate of patients without the three criteria was lower than that of patients with any one(p=0.033).Logistic regression model was used to analyze the risk factors of trauma(p=0.022).Compared with this,the risk factors of nonunion(p=0.053)and periosteal reaction or hyperosteogeny(p=0.060)were lower.Conclusion:For orthopaedic surgeons considering the recurrence rate of bone-related infections,trauma and fracture will significantly affect their prognosis,and the possibility of recurrence is higher than that without trauma and fracture.The three diagnostic indicators selected also have a significant impact on the recurrence rate.When discussing multivariate analysis,trauma,fracture and three diagnostic indicators will be the most important factors affecting recurrence rate.From the perspective of avoiding recurrence,if patients have the above-mentioned situation,specific debridement scope and adequate use of antibiotics after surgery will be the best strategy to prevent recurrence.