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ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Experimental Pharmacology and Drug Discovery
Volume 16 - 2025 |
doi: 10.3389/fphar.2025.1546191
This article is part of the Research Topic Innovations in Immunometabolic Treatment and Controlled Release Systems for Bone and Joint Disorders View all articles
The Lower Rate of Bone and Joint Infection in patients with Open Extremity Fractures Associated with Vaccination prior to Injury: A Propensity-Matched Cohort Study
Provisionally accepted- Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
Background Vaccines could strengthen the innate immune system in addition to conferring protection against their target pathogen via vaccine-induced immunomodulation, a phenomenon termed trained immunity. The purpose of the present study was to determine whether vaccination prior to injury is associated with a lower bone and joint infections (BJIs) rate in patients with Open Extremity Fractures.Patients with an open extremity fracture treated at one hospital between January 2010 and December 2019 were identified. Incidental vaccine recipients and control cohorts were matched in a 1:1 ratio using propensity scores based on age, sex, anatomical location of fracture, Gustilo-Anderson classification, BMI, and diagnosis of diabetes. Primary endpoint was BJIs within one year after initial injury. Secondary outcomes were neutrophil counts and serum C-reactive protein (CRP) level within 24 hours of admission. Logistic or linear regression was performed to control for potential confounding factors when comparing primary and secondary outcomes.Vaccine inoculation history was successfully collected from 6338 patients, with only 83 patients receiving an incidental vaccine inoculation within the three months prior to injury.After propensity-score matching, demographic and clinical factors were well balanced between cohorts (all standardized differences > 0.1). After controlling for potential confounders, patients in the vaccine group were at lower risk of BJIs after open extremity fracture (vaccine, 2/83 [2.4%]; control, 10/83 [12.0%), p=0.011). Levels of circulating neutrophils and CRP were slightly risen in the vaccine group.Vaccine inoculation is associated with the lower BJIs rate after open extremity fractures and vaccinated patients might have a more robust immune response against bacterial challenges in terms of neutrophil and CRP levels after injury. Future prospective cohort studies and clinical trials are warranted to evaluate this finding definitively. Trail registration ChiCTR2000041093. Registered 2020/12/17-retrospectively registered, http://www.chictr.org.cn/usercenter.aspx
Keywords: Bone and joint infection, Vaccine, Propensity-Matched Cohort Study, trained immunity, Fracture
Received: 16 Dec 2024; Accepted: 03 Feb 2025.
Copyright: © 2025 Hu, Shi, Lin, Gao, Shen, Sun, Wei and Zheng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xianyou Zheng, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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