Impact of infectious disease specialist consultations on antibiotic treatment and outcomes of fracture-related infections

Purpose The management of fracture-related infections (FRIs) is complex and requires collaboration among various specialists, including trauma and orthopedic surgeons, infectious disease (ID) specialists, and microbiologists. This study aimed to investigate the effects of ID consultations on antibiotic treatment and FRI outcomes. Methods We conducted a retrospective chart review of data from adult patients with microbiologically diagnosed FRIs at a tertiary care hospital. Results In total, 123 patients with FRIs were included in the study, with a median follow-up period of 31 months. Sixty-five patients (52.8%) received continuous ID consultations until the completion of their treatment, whereas 58 patients (47.2%) either did not receive any ID consultations or had their consultations terminated prematurely. The patients who received continuous ID consultations were more likely to receive pathogen-directed oral antibiotics (76.9% vs. 36.2%; P  < 0.001), biofilm-active antibiotics (52.3% vs. 8.6%; P  < 0.001), and prolonged antibiotic treatment (median, 50 vs. 26 days; P  < 0.001) than those who did not receive such consultations. The multivariate analysis results indicated that Gustilo–Anderson grade 3 open fractures (adjusted odds ratio [aOR], 3.82; P  = 0.002), implant retention (aOR, 3.01; P  = 0.02), and absence or early termination of ID consultations (aOR, 3.17; P  = 0.009) were independent predictors of treatment failure. Recurrence was less frequent in the patients who received biofilm-active agents than in those who did not (10.3% vs. 35.7%; P  = 0.007). Conclusion In patients with FRI, appropriate ID consultations were associated with frequent use of biofilm-active antibiotics and improved outcomes.