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

Abstract

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).

Figure 1

Geographic coverage of participants, dynamic changes of infection rate and related epidemiological data of post-traumatic related limb osteomyelitis (PTRLO). The geographical coverage of all participating hospitals (A), the infection rates (B) and affected gender (C) and age (D) of all regions; the distributions of all populations and pathogen (E) and affected limb sites (F) and the cause of injury (G).

Figure 2

The total number of cases and infection rates of pathogens and the top dominant strains have been tracked over the past decade. The total number of pathogen (Gram postive and negative bacteria) (A), and infection rate (IR, in dotted lines) or composition ration (CR, in solid lines) (B) of over the past ten years. The dynamic changes of top four Gram-positive strains (MSSA, MRSA, E. faecalls, S. epidermidis) and others in number (C) and persentage (D). The dynamic changes of top five Gram-negative strains (PAE, E.cloacae, E. coil, ABA, KPN) and others in number (E) and persentage (F).

Figure 3

The statistical results of analyses comparing antibiotic resistance and sensitivity in Gram-positive bacteria across 20 commonly available antibiotics were evaluated in the presence of complications or comorbidities. The statistical results of those top bacteria are shown in A) MSSA; B) MRSA; C) E. faecalis; D) S.epidermidis; E) Other positive bacteria, respectively. NA means no data applied.

Figure 4

The statistical results of analyses comparing antibiotic resistance and sensitivity in Gram-negative bacteria across 20 commonly available antibiotics were evaluated in the presence of complications or comorbidities. The statistical results of the top bacteria are shown as follows: (A) Pseudomonas aeruginosa; (B) Enterobacter cloacae; (C) Escherichia coli; (D) Acinetobacter baumannii; (E) Klebsiella pneumoniae; (F) Other Gram-negative bacteria. "NA" indicates no data available.