MUSCULOSKELETAL INFECTION

The present study summarizes the changes in the prevalence, microbiology, and risk factors of FRI during this period. A prospective single-center cohort study assessed in the setting of COVID-19 pandemic (2020-2021), clinical, microbiological aspects, and independent risk factors (RF) of FRI. RFs were estimated by bivariate and multivariate analyses using prevalence ratio (PR) with significance at P < 0.05. Kaplan-Meier analysis was performed to evaluate treatment outcomes. Overall, 132 patients were analyzed, with patients with age over 65 years accounting 65.1%. FRI was diagnosed in 21(15.9%) patients. Independent RFs for FRI were recent and preoperative use of systemic antibiotics (PR: 7.0, 95% confidence interval (95% CI): 2.2 – 22.4, p = 0.001) and neoplasm (PR: 9.8, 95% CI: 2.0 – 48.8, p = 0.005). Cultures yielded Gram-negative bacteria in 77.8%, 33.3% were MDR. Conclusions: We found higher rates of FRI, predominating in the elderly with closed femoral fractures during the COVID-19 pandemic. Previous use of antibiotics and immunosuppression conditions were independent factor for FRI. Our outcomes provide evidence to avoid the empirical use of antibiotics prior to surgery for fracture stabilization本研究总结了此期间骨折相关感染（Fracture-Related Infection, FRI）的流行率、微生物学特征及危险因素的变化。本研究为一项开展于2020-2021年新型冠状病毒肺炎（COVID-19）大流行期间的前瞻性单中心队列研究，旨在评估骨折相关感染的临床特征、微生物学特点及独立危险因素（RF）。危险因素通过双变量及多变量分析进行估算，采用患病率比（prevalence ratio, PR）作为效应指标，以P<0.05作为统计学显著性检验水准。采用Kaplan-Meier分析评估患者的治疗结局。本研究共纳入132例患者进行分析，其中年龄超过65岁者占比65.1%。共有21例（15.9%）患者被诊断为骨折相关感染。骨折相关感染的独立危险因素包括近期及术前全身性抗菌药物使用（PR=7.0，95%置信区间（95% CI）：2.2~22.4，P=0.001）以及肿瘤病史（PR=9.8，95%置信区间（95% CI）：2.0~48.8，P=0.005）。病原菌培养结果显示，革兰阴性菌占比77.8%，其中多重耐药菌（Multidrug-Resistant, MDR）占33.3%。结论：本研究发现，在新型冠状病毒肺炎大流行期间，骨折相关感染的发生率更高，主要好发于老年股骨闭合性骨折患者。术前及近期抗菌药物使用、免疫抑制状态为骨折相关感染的独立危险因素。本研究结果可为避免骨折复位固定术前经验性使用抗菌药物提供循证依据。