Helbig L, et al. - The intention of the authors was to scrutinize the peri- and postoperative antibiotic regime in terms of the microbial spectrum and antibiotic resistances of patients with infected nonunions of the long bones. Additionally, they contemplated the possible effect on healing rates. Data displayed that initial antibiotic therapy consisting of systemic cefuroxime plus local gentamicin-loaded bone cement was effective, besides the high variety of different detected species. In approximately 90% cases, the later indicated that microbial infection was sensitive to this therapy. Initial treatment was recommended according to this algorithm until the availability of specific antibiograms from intraoperatively acquired tissue samples.

Methods

• Researchers analyzed all patients with first revision surgery (during 2010-2015) due to nonunion of long bones with a clinical history of infection treated with radical debridement, local application of a gentamicin-impregnated bone cement and systemic cefuroxime.
• Mean follow-up was found to be 34.2 months.
• Data was extracted via a computerized databank with information about microbial species from intraoperatively acquired tissue samples and respective antibiograms.
• An assessment was performed of the bone fusion rates on the basis of latest X-ray and computed tomography scan findings.

Results

• The enrollment consisted of 212 patients with nonunion and history of infection.
• A total of 171 patients presented with a positive intraoperative microbial evidence of infection.
• Mostly positive findings were obtained in the bacterial testing in fractures of the tibia (47.4%) and the femur (27.5%).
• It was determined that coagulase-negative Staphylococcus spp. were the most frequently detected (44.4%) entity followed by mixed infections (18.7%) and Staphylococcus aureus (10.5%).
• As disclosed via antibiograms, 62.6% of the cases were cefuroxime sensitive; 87.7% were gentamicin sensitive.
• Resistance to both cefuroxime and gentamicin was discovered in only 10.5% cases .
• No statistically prominent variation was found in the fusion rates between patients with different microbial species or different antibiograms.