{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T07:54:30Z","timestamp":1767772470595,"version":"build-2065373602"},"reference-count":49,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,5,18]],"date-time":"2024-05-18T00:00:00Z","timestamp":1715990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Despite the implications of trochanteric and subtrochanteric intramedullary (IM) nail infection for patients with hip fracture, little is known about risk factors for therapeutic failure and mortality in this population. We performed a retrospective observational analysis including patients diagnosed with trochanteric and subtrochanteric IM nail infection at a Spanish academic hospital during a 10-year period, with a minimum follow-up of 22 months. Of 4044 trochanteric and subtrochanteric IM nail implants, we identified 35 cases of infection during the study period (0.87%), 17 of which were chronic infections. Patients with therapeutic failure (n = 10) presented a higher average Charlson Comorbidity Index (CCI) (5.40 vs. 4.21, p 0.015, CI 0.26\u20132.13) and higher rates of polymicrobial (OR 5.70, p 0.033, CI 1.14\u201328.33) and multidrug-resistant (OR 7.00, p 0.027, CI 1.24\u201339.57) infections. Upon multivariate analysis, polymicrobial infection and the presence of multidrug-resistant pathogens were identified as independent risk factors for therapeutic failure. Implant retention was associated with an increased risk of failure in chronic infection and was found to be an independent risk factor for overall one-year mortality in the multivariate analysis. Our study highlights the importance of broad-spectrum empirical antibiotics as initial treatment of trochanteric and subtrochanteric IM nail-associated infection while awaiting microbiological results. It also provides initial evidence for the importance of implant removal in chronic IM-nail infection.<\/jats:p>","DOI":"10.3390\/antibiotics13050463","type":"journal-article","created":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T08:20:31Z","timestamp":1716193231000},"page":"463","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Risk Factors for Therapeutic Failure and One-Year Mortality in Patients with Intramedullary Nail-Associated Infection after Trochanteric and Subtrochanteric Hip Fracture Repair"],"prefix":"10.3390","volume":"13","author":[{"given":"Bernadette","family":"Pfang","sequence":"first","affiliation":[{"name":"Unidad de Innovaci\u00f3n Cl\u00ednica y Organizativa, Red Quir\u00f3nsalud 4H, 28040 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Fundaci\u00f3n Jim\u00e9nez D\u00edaz, UAM, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco A.","family":"Villegas Garc\u00eda","sequence":"additional","affiliation":[{"name":"Industrial Engineering Politecnic, University of Castilla-La Mancha, 13071 Ciudad Real, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3415-2478","authenticated-orcid":false,"given":"Antonio","family":"Blanco Garc\u00eda","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Fundaci\u00f3n Jim\u00e9nez D\u00edaz, 28040 Madrid, Spain"},{"name":"CIBERINFEC-CIBER de Enfermedades Infecciosas, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3771-5598","authenticated-orcid":false,"given":"\u00c1lvaro","family":"Au\u00f1\u00f3n Rubio","sequence":"additional","affiliation":[{"name":"CIBERINFEC-CIBER de Enfermedades Infecciosas, 28029 Madrid, Spain"},{"name":"Orthopedic Surgery and Traumatology Department, Hospital Fundaci\u00f3n Jim\u00e9nez D\u00edaz, 28040 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8971-3167","authenticated-orcid":false,"given":"Jaime","family":"Esteban","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Sanitaria Fundaci\u00f3n Jim\u00e9nez D\u00edaz, UAM, 28040 Madrid, Spain"},{"name":"CIBERINFEC-CIBER de Enfermedades Infecciosas, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joaqu\u00edn","family":"Garc\u00eda Ca\u00f1ete","sequence":"additional","affiliation":[{"name":"Industrial Engineering Politecnic, University of Castilla-La Mancha, 13071 Ciudad Real, Spain"},{"name":"CIBERINFEC-CIBER de Enfermedades Infecciosas, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,18]]},"reference":[{"key":"ref_1","first-page":"e201911072","article-title":"Spanish National Hip Fracture Registry (RNFC): First-year Results and Comparison with Other Registries and Prospective Multicentric Studies from Spain","volume":"93","year":"2019","journal-title":"Rev. Esp. Salud P\u00fablica"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e2317164","DOI":"10.1001\/jamanetworkopen.2023.17164","article-title":"Intramedullary Nailing vs. Sliding Hip Screw in Trochanteric Fracture Management: The INSITE Randomized Clinical Trial","volume":"6","author":"Schemitsch","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Yoon, J.Y., Park, S., Kim, T., and Im, G.I. (2022). Cut-out risk factor analysis after intramedullary nailing for the treatment of extracapsular fractures of the proximal femur: A retrospective study. BMC Musculoskelet. Disord., 23.","DOI":"10.1186\/s12891-022-05054-w"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"E1550","DOI":"10.5435\/JAAOS-D-22-00213","article-title":"Mechanical Complications After Intramedullary Fixation of Extracapsular Hip Fractures","volume":"30","author":"Klima","year":"2022","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_5","first-page":"278","article-title":"Intramedullary Nailing of Intertrochanteric Femoral Fractures in a Level I Trauma Center in Finland: What Complications Can be Expected?","volume":"482","author":"Ylitalo","year":"2023","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1111\/tme.12904","article-title":"Blood loss and transfusion risk in intramedullary nailing for subtrochanteric fractures","volume":"33","author":"Panteli","year":"2023","journal-title":"Transfus. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1016\/j.injury.2020.10.076","article-title":"Infections after intramedullary fixation of trochanteric fractures are uncommon and implant removal is not usually needed","volume":"52","author":"Halonen","year":"2021","journal-title":"Injury"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1007\/s11999-014-4123-7","article-title":"Cochrane in CORR\u00ae: Intramedullary Nails for Extracapsular Hip Fractures in Adults (Review)","volume":"473","author":"Evaniew","year":"2015","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1038\/s41598-024-51180-x","article-title":"Surgical site infection after trochanteric and subtrochanteric fractures: A single centre retrospective analysis","volume":"14","author":"Sator","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1001\/jamainternmed.2013.9763","article-title":"Health Care\u2013Associated Infections: A Meta-analysis of Costs and Financial Impact on the US Health Care System","volume":"173","author":"Zimlichman","year":"2013","journal-title":"JAMA Intern. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1086\/502033","article-title":"The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: Adverse quality of life, excess length of stay, and extra cost","volume":"23","author":"Whitehouse","year":"2002","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.injury.2016.09.019","article-title":"Infection after fracture fixation: Current surgical and microbiological concepts","volume":"49","author":"Metsemakers","year":"2018","journal-title":"Injury"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s13018-017-0535-x","article-title":"Effect of a standardized treatment regime for infection after osteosynthesis","volume":"12","author":"Hellebrekers","year":"2017","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1007\/s00068-019-01182-6","article-title":"The effect of early broad-spectrum versus delayed narrow-spectrum antibiotic therapy on the primary cure rate of acute infection after osteosynthesis","volume":"46","author":"Hellebrekers","year":"2020","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1111\/joim.12233","article-title":"Clinical presentation and treatment of orthopaedic implant-associated infection","volume":"276","author":"Zimmerli","year":"2014","journal-title":"J. Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S82","DOI":"10.1016\/j.injury.2017.04.026","article-title":"Current treatment of infected non-union after intramedullary nailing","volume":"48","author":"Simpson","year":"2017","journal-title":"Injury"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1055\/s-0038-1634956","article-title":"Risk adjustment in outcome assessment: The Charlson comorbidity index","volume":"32","author":"Sicotte","year":"1993","journal-title":"Methods Inf. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.injury.2017.08.040","article-title":"Fracture-related infection: A consensus on definition from an international expert group","volume":"49","author":"Metsemakers","year":"2018","journal-title":"Injury"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.2106\/JBJS.20.00257","article-title":"Determining Diagnostic Thresholds for Acute Postoperative Periprosthetic Joint Infection","volume":"102","author":"Sukhonthamarn","year":"2020","journal-title":"J. Bone Jt. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1093\/biomet\/80.1.27","article-title":"Bias reduction of maximum likelihood estimates","volume":"80","author":"Firth","year":"1993","journal-title":"Biometrika"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.2106\/JBJS.22.01245","article-title":"Comparison of Intramedullary Nails in the Treatment of Trochanteric and Subtrochanteric Fractures: An Observational Study of 13,232 Fractures in the Norwegian Hip Fracture Register","volume":"105","author":"Dybvik","year":"2023","journal-title":"J. Bone Jt. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"E0026","DOI":"10.2106\/JBJS.OA.17.00026","article-title":"Implant-Related Complications and Mortality After Use of Short or Long Gamma Nail for Intertrochanteric and Subtrochanteric Fractures: A Prospective Study with Minimum 13-Year Follow-up","volume":"2","author":"Horner","year":"2017","journal-title":"JBJS Open Access"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.otsr.2019.06.022","article-title":"Factors associated with mortality due to trochanteric fracture. A cross-sectional study","volume":"106","author":"Velez","year":"2020","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"198","DOI":"10.7150\/jbji.35428","article-title":"Prosthetic-joint infections: Mortality over the last 10 years","volume":"4","author":"Fischbacher","year":"2019","journal-title":"J. Bone Jt. Infect."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1016\/S1473-3099(18)30345-1","article-title":"Risk factors associated with revision for prosthetic joint infection after hip replacement: A prospective observational cohort study","volume":"18","author":"Lenguerrand","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_26","first-page":"427","article-title":"Deep Infection after Distal Radius Open-reduction Internal Fixation: A Case Series","volume":"9","author":"Henry","year":"2021","journal-title":"Arch. Bone Jt. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1302\/0301-620X.101B7.BJJ-2018-1189.R1","article-title":"Prior hip or knee prosthetic joint infection in another joint increases risk three-fold of prosthetic joint infection after primary total knee arthroplasty: A matched control study","volume":"101","author":"Chalmers","year":"2019","journal-title":"Bone Jt. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1086\/524667","article-title":"Influence of vancomycin minimum inhibitory concentration on the treatment of methicillin-resistant Staphylococcus aureus bacteremia","volume":"46","author":"Soriano","year":"2008","journal-title":"Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_29","first-page":"786.e9","article-title":"KLIC-score for predicting early failure in prosthetic joint infections treated with debridement, implant retention and antibiotics","volume":"21","author":"Tornero","year":"2015","journal-title":"Clin. Microbiol. Infect. Off. Publ. Eur. Soc. Clin. Microbiol. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s00590-021-03156-0","article-title":"Empiric antibiotic therapy in early periprosthetic joint infection: A retrospective cohort study","volume":"33","author":"Scholten","year":"2023","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jinf.2007.01.007","article-title":"Guiding empirical antibiotic therapy in orthopaedics: The microbiology of prosthetic joint infection managed by debridement, irrigation and prosthesis retention","volume":"55","author":"Moran","year":"2007","journal-title":"J. Infect."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"732.e1","DOI":"10.1016\/j.cmi.2016.05.004","article-title":"Time trends in the aetiology of prosthetic joint infections: A multicentre cohort study","volume":"22","author":"Benito","year":"2016","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.arth.2017.07.045","article-title":"Multidrug-Resistant Organisms in the Setting of Periprosthetic Joint Infection\u2014Diagnosis, Prevention, and Treatment","volume":"33","author":"Siljander","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.arth.2011.03.044","article-title":"Prosthetic Joint Infection Caused by Gram-Negative Organisms","volume":"26","author":"Zmistowski","year":"2011","journal-title":"J. Arthroplast."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.jinf.2022.07.009","article-title":"Epidemiology and antibiotic resistance of prosthetic joint infections according to time of occurrence, a 10-year study","volume":"85","author":"Casenaz","year":"2022","journal-title":"J. Infect."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Benito, N., Mur, I., Ribera, A., Soriano, A., Rodriguez-Pardo, D., Sorli, L., Cobo, J., Fernandez-Sampedro, M., Del Toro, M.D., and Gu\u00edo, L. (2019). The Different Microbial Etiology of Prosthetic Joint Infections according to Route of Acquisition and Time after Prosthesis Implantation, Including the Role of Multidrug-Resistant Organisms. J. Clin. Med., 8.","DOI":"10.3390\/jcm8050673"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Pfang, B.G., Garc\u00eda-Ca\u00f1ete, J., Garc\u00eda-Lasheras, J., Blanco, A., Au\u00f1\u00f3n, \u00c1., Parron-Cambero, R., Mac\u00edas-Valcayo, A., and Esteban, J. (2019). Orthopedic Implant-Associated Infection by Multidrug Resistant Enterobacteriaceae. J. Clin. Med., 8.","DOI":"10.3390\/jcm8020220"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1086\/605593","article-title":"Gram-negative prosthetic joint infections: Risk factors and outcome of treatment","volume":"49","author":"Hsieh","year":"2009","journal-title":"Clin. Infect. Dis."},{"key":"ref_39","first-page":"11","article-title":"Multidrug-resistant bacteria: An independent predictor of failure in peri-prosthetic joint infection","volume":"98-B","author":"Sadique","year":"2016","journal-title":"Orthop. Proc."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Rudelli, B.A., Giglio, P.N., de Carvalho, V.C., P\u00e9cora, J.R., Gurgel, H.M.C., Gobbi, R.G., Vicente, J.R.N., Lima, A.L.L.M., and Helito, C.P. (2020). Bacteria drug resistance profile affects knee and hip periprosthetic joint infection outcome with debridement, antibiotics and implant retention. BMC Musculoskelet. Disord., 21.","DOI":"10.1186\/s12891-020-03570-1"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Koch, K.A., Spranz, D.M., Westhauser, F., Bruckner, T., Lehner, B., Alvand, A., Merle, C., and Walker, T. (2023). Impact of Comorbidities and Previous Surgery on Mid-Term Results of Revision Total Knee Arthroplasty for Periprosthetic Joint Infection. J. Clin. Med., 12.","DOI":"10.3390\/jcm12175542"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1038\/s41598-020-58453-1","article-title":"The impact of age and comorbidity on the postoperative outcomes after emergency surgical management of complicated intra-abdominal infections","volume":"10","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1016\/j.ajic.2015.05.004","article-title":"Bacteremia caused by multidrug-resistant bacteria in a French university hospital center: 3 years of collection","volume":"43","author":"Batailler","year":"2015","journal-title":"Am. J. Infect. Control"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1007\/s40520-015-0364-x","article-title":"The burden of comorbidity is associated with symptomatic polymicrobial urinary tract infection among institutionalized elderly","volume":"27","author":"Laudisio","year":"2015","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.arth.2020.07.081","article-title":"Success Rates of Debridement, Antibiotics, and Implant Retention in 230 Infected Total Knee Arthroplasties: Implications for Classification of Periprosthetic Joint Infection","volume":"36","author":"Zhu","year":"2021","journal-title":"J. Arthroplast."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1111\/apm.12687","article-title":"Orthopaedic biofilm infections","volume":"125","author":"Zimmerli","year":"2017","journal-title":"APMIS"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Peel, T.N. (2019). Studying biofilm and clinical issues in orthopedics. Front. Microbiol., 10.","DOI":"10.3389\/fmicb.2019.00359"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1080\/17453674.2020.1717841","article-title":"Surgical site infection after hip fracture-mortality and risk factors: An observational cohort study of 1709 patients","volume":"91","author":"Pollmann","year":"2020","journal-title":"Acta Orthop."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"108","DOI":"10.7150\/jbji.24285","article-title":"Treatment of Prosthetic Joint Infection with Debridement, Antibiotics and Irrigation with Implant Retention\u2014A Narrative Review","volume":"3","author":"Sousa","year":"2018","journal-title":"J. Bone Jt. Infect."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/5\/463\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:44:22Z","timestamp":1760107462000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/5\/463"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,18]]},"references-count":49,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["antibiotics13050463"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics13050463","relation":{},"ISSN":["2079-6382"],"issn-type":[{"type":"electronic","value":"2079-6382"}],"subject":[],"published":{"date-parts":[[2024,5,18]]}}}