Diagnostic performance of bone histopathology in fracture-related infection at a specialized hospital in Uruguay
DOI:
https://doi.org/10.58814/01208845.657Keywords:
Fractures, Fracture Fixation, Surgical Wound Infection, Histology, Diagnosis, Bone Diseases, InfectiousAbstract
Introduction: Fracture-related infections (FRI) are among the most complex complications in orthopedic trauma, with significant functional and economic impact. The AO/EBJIS 2018 consensus established standardized diagnostic criteria including bone histopathology as a confirmatory criterion; however, its performance has been scarcely evaluated in Latin America.
Objectives: To characterize FRI in a national referral center and evaluate the diagnostic performance of bone histopathology compared with intraoperative culture.
Methodology: A prospective observational study was conducted between January 1, 2021 and February 29, 2024 at the National Institute of Orthopedics and Traumatology (Montevideo, Uruguay). Adults (≥18 years) with suspected or confirmed FRI undergoing surgery with deep tissue sampling for microbiological culture and histopathology were included. Each patient was included once. Vertebral fractures, prosthetic joint infections, superficial samples, and cases without analyzable samples were excluded. AO/EBJIS 2018 criteria were applied. Histopathological performance was evaluated using culture as reference, calculating sensitivity, specificity, predictive values, and 95% confidence intervals.
Results: A total of 67 patients were analyzed (mean age 43 ± 17.80 years; 73.13% male). Predisposing factors were present in 73.13%, open fractures in 52.24%, and lower limb involvement in 94.03%. Positive cultures were obtained in 77.61% (52/67), with polymicrobial infections in 36.54%. The most frequent pathogens were Staphylococcus aureus (36.49%), Enterococcus spp. (9.46%), and Gram-negative bacilli (27%); 18.75% of Staphylococcus spp. were methicillin-resistant and 44.44% of Enterobacterales isolates were multidrug-resistant. Histopathology was positive in 65.67% (44/67), with sensitivity 73.08%, specificity 60%, PPV 86.36%, and NPV 39.13%. In non-union (n=31), sensitivity was 80% and PPV 76.19%.
Conclusions: Fracture-related infections are associated with high-energy trauma and a high proportion of multidrug-resistant organisms. Bone histopathology is a complementary diagnostic tool to culture, with greater confirmatory than exclusion value, particularly in non-union.
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