INFECTIONS AFTER HIP FRACTURE: A COMPLICATION WITH INCREASED MORTALITY. CAN THEY BE REDUCED?

Aim Several measures have been described to prevent prosthetic joint infection in proximal femur fractures, such as personalized antibiotic prophylaxis. The use of antibiotic-loaded cement has also been proposed, although evidence remains limited, particularly in the context of local antimicrobial resistance patterns. The aim of this study was to evaluate the influence of antibiotic-loaded bone cement in the infection rates of partial hip prosthesis for intracapsular femoral fractures. Secondary, the mortality risk of infected patients was also assessed. Method This is a multicenter, quasi-experimental before-after intervention study conducted in three Catalan hospitals. All cemented partial hip prostheses implanted due to intracapsular femoral fracture during the study period were included. In the intervention group (January 2023–December 2024), preloaded cement with vancomycin and gentamicin was used. In the historical control group (January 2020–December 2022), cement without antibiotics (or with a single aminoglycoside) was used. The primary outcome was prosthetic joint infection as defined by EBJIS criteria. Pearson's Chi-square test was used to analyze the primary variable, and Student's t-test was used for demographic comparisons between groups. Results A total of 994 patients were included: 458 in the historical cohort and 536 in the intervention group (cement with vancomycin and gentamicin). No significant differences were found between groups regarding age (p=0.09), sex (p=0.07), BMI (p=0.196), or comorbidities such as diabetes mellitus (p=0.265) or chronic kidney disease (p=0.375), nor in complications during hospitalization (p=0.296). There were 24 infections in total (2.41%): 9 in the gentamicin and vancomycin group (1.7%) and 15 in the control group (3.3%) (p=0.145). The group cemented without antibiotics showed an increased risk of infections (p<0,05) Overall mortality rate was 12.7%. One-year postoperative mortality was 41.7% among infected patients compared to 12.6% in non-infected patients (p=0.01). Conclusions The use of antibiotic-loaded bone cement for fixation of partial hip prostheses reduces the risk of periprosthetic infection in patients with intracapsular femoral fractures. Infection after hip fracture has an increased risk of mortality.