• Cristina Ojeda-Thies, Ana Rojo-Carpintero, Francisco Soria-Perdomo, and Luis Rafael Ramos-Pascua.
• Department of Traumatology and Orthopaedic Surgery, 12 de Octubre University Hospital Madrid, Spain. Electronic address: cristina.ojeda@salud.madrid.org.
• Injury. 2024 Oct 1; 55 Suppl 5: 111756111756.

AimsOur study aimed to evaluate the prognosis of implant-related infection following hip fracture and pre-surgical, surgical and microbiological factors modifying outcomes.MethodsWe retrospectively included patients aged 65 and older treated for infection following surgically managed hip fractures between 2012 and 2022. Periprosthetic and high-energy fractures were excluded. Data was obtained by clinical chart review, including: age, gender, Barthel index, Charlson Score, National Hip Fracture Database (NHFD) Mobility Score, surgery and infection type, causative pathogens, antimicrobial resistance, anti-biofilm antibiotic treatment and clinical situation at one-year follow up. The outcomes evaluated were failure/resolution of infection and one-year mortality.ResultsWe included 80 patients (67 women, 83.8 %) aged a median of 85 years (interquartile range: 78 - 88 years). Treatment failed in 38 (47.5 %) patients, and the one-year mortality was 37.5 %. Patients dying within 12 months after treatment were more likely to suffer acute vs. chronic infections (OR = 3.29 [95 %CI: 1.20-9.04]), be older and have more comorbidity, but baseline function and ambulation were not predictive. Treatment failure was higher among patients receiving non-antibiofilm controlling surgery, specifically surgical lavage (OR = 3.79 [95 %CI: 1.38-10,37]), as well as in older, more dependent patients. Receiving anti-biofilm antibiotics for more than 2 weeks was associated with less treatment failure (OR:0.32; [95 %CI: 0.13-0.80]) and 12-month mortality (OR:0.22 [95 %CI: 0.08-0.60]).ConclusionsAntibiofilm-controlling surgery and antibiotics improve treatment success following implant-related infection after hip fracture and should be considered regardless of fracture type. Acute infections are a "second hit" for frail patients recovering from initial surgery and are associated with increased mortality.Copyright © 2024. Published by Elsevier Ltd.

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