Epidemiological Updates to Be Clarified of PTRLO in China: A 10 Years Multicenter Study

Background: We aimed to carry out a comprehensive multiple-center epidemiological study of post-traumatic related limb osteomyelitis (PTRLO) in China. Methods: Approved by the Institutional Research Board (IRB), 3,526 PTRLO patients were identified from 212,394 traumatic limb fracture patients from 21 hospitals between January 1st, 2008- December 31st, 2017 to conduct an epidemiological retrospective analysis, which includes dynamic changes of infection rate (IR), pathogens, infection risk factors, and antibiotics resistant and sensitivity during the past decade. Findings: The IR of PTRLO gradually increased from 0.93% to 2.16% (Z=14.392, p 0.05). The dominant strains of GP are MSSA (17.03%), MRSA (10.46%), E. faecalis (5.19%), and S. epidermidis (4.87%). The dominant strains of GN are Pseudomonas Aeruginosa (10.92%), E. cloacae (10.34%), E.coli (9.47%), Acinetobacter Baumannii (7.92%) & Klebsiella Pneumoniae (3.33%). Overall, the high-risk factors of PI are open-fracture (odds ratio, 2.223), hypoproteinemia (odds ratio, 2.328), and multiple fractures (odds ratio, 1.465). The antibiotic-resistance and sensitivity analysis of the pathogens could be influenced by the complications or comorbidities. Interpretation: The current study demonstrates the epidemiology of PTRLO of a patient population in China, and provides a useful information for patient care and clinical practice. Trial Registration: The study is registered with the Chinese clinical trials registry (ChiCTR1800017597). Funding: National Natural Science Foundation of China, Technological Innovation Projects of Southwest Hospital of China, and AO Trauma Clinical Priority Program on Bone Infection. Declaration of Interests: All other authors declare no competing interests. Ethics Approval Statement: Approved by the Institutional Research Board (IRB)