Clinical, Microbiological, and Therapeutic Profile of Multidrug-Resistant Fracture-Related Infections and Prosthetic Joint Infections

Aim Fracture-related infections (FRI) and prosthetic joint infections (PJI) are severe complications associated with significant morbidity and a high risk of therapeutic failure. The emergence of multidrug-resistant (MDR) bacteria further complicates their management by limiting available antibiotic options. This study aimed to describe the clinical, microbiological, and therapeutic characteristics of MDR infections occurring in FRI and PJI. Methods We conducted a retrospective descriptive study including patients with MDR infections in FRI and PJI between 2023 and 2025. Demographic, clinical, biological, microbiological, and therapeutic data were collected from medical records. Qualitative variables were expressed as percentages and quantitative variables as medians. Results A total of 52 patients were included, with a median age of 65 years and a female predominance (n=36; 69.2%). The infection was a PJI in 36.5% (n=19) and a FRI in 63.5% (n=33). Clinically, pain was present in 69.2% (n=36), functional impairment in 53.8% (n=28), and fever in 44.2% (n=23). Diabetes mellitus was identified in 50% (n=26) of patients. The median C-reactive protein level was 31 mg/L, and the median leukocyte count was 9,145/mm 3 . Infections were predominantly caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae (n=16; 30.8%), followed by methicillin-resistant Staphylococcus aureus (n=12; 23.1%). ESBL-producing Escherichia coli was identified in 9.6% (n=5), and multidrug-resistant Acinetobacter spp . in 5.8% (n=3). Extensively drug-resistant Klebsiella pneumoniae and carbapenemase-producing Enterobacteriaceae were each identified in 3.8% (n=2). Empirical postoperative antibiotic therapy was initiated in 98.1% (n=51), most commonly using piperacillin–tazobactam plus vancomycin (n=12; 23.1%), cefotaxime plus vancomycin (n=10; 19.2%), imipenem plus vancomycin (n=9; 17.3%), and piperacillin–tazobactam plus teicoplanin (n=7; 13.5%). Oral step-down therapy was administered in 84.6% (n=44), predominantly with pristinamycin plus ciprofloxacin (n=8; 18.2%), sulfamethoxazole–trimethoprim plus ciprofloxacin (n=6; 13.6%), and amoxicillin–clavulanic acid plus ciprofloxacin (n=4; 9.1%). Other regimens included ciprofloxacin monotherapy (n=3; 6.8%), sulfamethoxazole–trimethoprim (n=2; 4.5%), and pristinamycin (n=2; 4.5%). The median duration of antibiotic therapy was 60 days. Surgical management was performed in all patients, consisting of implant removal in 80.8% (n=42) of cases. Conclusion MDR FRI and PJI were predominantly caused by resistant Enterobacteriaceae . The frequent use of broad-spectrum empirical antibiotic therapy followed by targeted adjustment highlights the critical role of local microbiological epidemiology in guiding management strategies.