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Multidisciplinary Treatment of Fracture-Related Infection Has a Positive Impact on Clinical Outcome—A Retrospective Case Control Study at a Tertiary Referral Center

ORCID
0000-0001-7221-3783
Affiliation
Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
Rupp, Markus;
ORCID
0000-0002-0654-2076
Affiliation
Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
Walter, Nike;
ORCID
0000-0002-3867-660X
Affiliation
Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
Popp, Daniel;
Affiliation
Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, 93053 Regensburg, Germany
Hitzenbichler, Florian;
Affiliation
Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, 93053 Regensburg, Germany
Heyd, Robert;
Affiliation
Center of Plastic and Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
Geis, Sebastian;
Affiliation
Department of Internal Medicine I, University Hospital Regensburg, 93053 Regensburg, Germany
Kandulski, Melanie;
Affiliation
Institute of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany
Thurn, Sylvia;
Affiliation
Department of Vascular Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
Betz, Thomas;
ORCID
0000-0002-6761-0247
Affiliation
Institute of Pathology, University Regensburg, 93053 Regensburg, Germany
Brochhausen, Christoph;
ORCID
0000-0003-0208-4650
Affiliation
Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
Alt, Volker

Objectives: Fracture-related infection (FRI) is a major complication in orthopedic and trauma surgery. The management and choice of treatment can be difficult depending on multiple factors. Therefore, we implemented a weekly multidisciplinary team discussion to determine diagnostic and treatment strategies in FRI patients and aimed to analyze its effect on clinical outcomes. Methods: Clinical outcomes of FRI patients treated before and after implementation of a structured multidisciplinary treatment (MDT) approach with a weekly case discussion were compared at a follow-up of 12 months. Results: In total, n = 117 were eligible for enrolment, whereby n = 58 patients (72.4% male, mean age 56.7 ± 16.8 years) constituted the MDT group and n = 59 patients (72.9% male, mean age 55.0 ± 16.5 years) the control group. In the MDT group more cases were treated with local antibiotics (67.2% vs. 27.1%, p < 0.001) and significant less amputations (3.4% vs. 6.8%, p = 0.014), as well as less revision surgeries (1.5 ± 1.2 (0–5) vs. 2.2 ± 1.2 (0–7), p = 0.048) were performed. A trend towards less debridement, antibiotics and implant retention (DAIR) procedures, lower rates of recurrence of infection and less treatment failures in the MDT group was observable, even though not statistically significant. Conclusion: An MDT approach providing a patient tailored treatment concept in the treatment of FRI patients appears to be beneficial for the affected patients. Quality and efficacy of implemented MDT meetings should further be evaluated to provide sufficient evidence to further implement this valuable tool in clinical practice and decision making.

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