Microbiological and functional outcomes after open extremity fractures sustained overseas: The experience of a UK level I trauma centre (original) (raw)
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Microbiology and injury characteristics in severe open tibia fractures from combat
The journal of trauma and acute care surgery, 2012
Type III open tibia fractures are common combat injuries. The purpose of the study was to evaluate the effect of injury characteristics and surveillance cultures on outcomes in combat-related severe open tibia fractures. We conducted a retrospective study of all combat-related open Gustilo and Anderson (G/A) type III diaphyseal tibia fractures treated at our centers between March 2003 and September 2007. One hundred ninety-two Operation Iraqi Freedom/Operation Enduring Freedom military personnel with 213 type III open tibial shaft fractures were identified. Fifty-seven extremities (27%) developed a deep infection and 47 extremities (22%) ultimately underwent amputation at an average follow-up of 24 months. Orthopedic Trauma Association type C fractures took significantly longer to achieve osseous union (p = 0.02). G/A type III B and III C fractures were more likely to undergo an amputation and took longer to achieve fracture union. Deep infection and osteomyelitis were significantly...
Early Outcome of Culture-Negative Infection in Open Fractures of the Lower Limb: A Prospective Study
Indian Journal of Medical Microbiology, 2019
Original Article introduction Open long bone fracture is commonly encountered in tertiary level orthopaedic trauma care. [1] Infection is a common complication of open fractures. Chronic osteomyelitis, non-union, loss of function or even limb loss are some serious complications of deep surgical site infections. Further, it contributes to increase in healthcare costs and decrease in the quality of life. [2] Primary goal in management of open fractures, in addition to achieving union, is prevention of infection by early debridement, irrigation of wound and administration of broad-spectrum antibiotics with stabilisation of fracture. [3] However, deep surgical site infection is common, and clinicians make treatment decisions based on signs and symptoms, laboratory and imaging workup and bacteriological culture results. The standard of care for treating infections which complicate open fractures involves accurately identifying the infecting microorganism and providing adequate antibiotic therapy based on culture and sensitivity. This is supplemented with additional surgical procedures as necessary. However, negative culture results are frequently encountered even when there are clinical signs of infection. Negative bacteriological culture results are challenging to the clinician, as they may be false-negative and empirical treatment of the same may result in inadequate resolution of infection and development of resistant microorganisms. [4] The reported incidence of culture-negative infections in orthopaedic trauma is 9%, but its incidence in open fractures and its outcome has not been described in the literature. [4] We aimed to identify the rate of culture-negative infections in open long bone fractures of the lower limb and study its Background: Culture-negative infections in open long bone fractures are frequently encountered in clinical practice. We aimed to identify the rate and outcome of culture-negative infections in open long bone fractures of lower limb. Methodology: A prospective cohort study was conducted from November 2015 to May 2017 on Gustilo and Anderson Grade III open long bone fractures of the lower limb. Demographic data, injury details, time from injury to receiving antibiotics and index surgical procedure were noted. Length of hospital stay, number of additional surgeries and occurrence of complications were also noted. Patients with infected open fractures were grouped as culture positive or culture negative depending on the isolation of infecting microorganisms in deep intraoperative specimen. The clinical outcome of these two groups was statistically analysed. Results: A total of 231 patients with 275 open fractures involving the femur, tibia or fibula were studied. There was clinical signs of infection in 84 patients (36.4%) with 99 fractures (36%). Forty-three patients (51.2%) had positive cultures and remaining 41 patients had negative cultures (48.8%). The rate of culture-negative infection in open type III long bone fractures in our study was 17.7%. There was no statistical difference in the clinical outcome between culture-negative and culture-positive infections. Conclusion: Failure to identify an infective microorganism in the presence of clinical signs of infection is routinely seen in open fractures and needs to be treated aggressively.
Prevention of Infections Associated With Combat-Related Extremity Injuries
Journal of Trauma: Injury, Infection & Critical Care, 2011
During combat operations, extremities continue to be the most common sites of injury with associated high rates of infectious complications. Overall, ϳ15% of patients with extremity injuries develop osteomyelitis, and ϳ17% of those infections relapse or recur. The bacteria infecting these wounds have included multidrug-resistant bacteria such as Acinetobacter baumannii, Pseudomonas aeruginosa, extended-spectrum -lactamase-producing Klebsiella species and Escherichia coli, and methicillin-resistant Staphylococcus aureus. The goals of extremity injury care are to prevent infection, promote fracture healing, and restore function. In this review, we use a systematic assessment of military and civilian extremity trauma data to provide evidence-based recommendations for the varying management strategies to care for combat-related extremity injuries to decrease infection rates. We emphasize postinjury antimicrobial therapy, debridement and irrigation, and surgical wound management including addressing ongoing areas of controversy and needed research. In addition, we address adjuvants that are increasingly being examined, including local antimicrobial therapy, flap closure, oxygen therapy, negative pressure wound therapy, and wound effluent characterization. This evidence-based medicine review was produced to support the Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update contained in this supplement of Journal of Trauma.
Medicina Moderna - Modern Medicine
Open fractures represent a challenging aspect of modern traumatology with high individual and social impact especially due to septic complications which require prolonged hospitalization, repeated surgery and considerable costs. That is why medical research is directed to establishing the most effi cient diagnostic and therapeutic algorithms able to decrease the incidence of septic complications and promote optimal fracture healing. The purpose of this paper is to underline the importance of early proper surgical debridement for the outcome of these fractures as reflected by the experience of a Level 1 Trauma Centre in order to include this aspect into future therapeutical guidelines.
Pathogens Present in Acute Mangled Extremities From Afghanistan and Subsequent Pathogen Recovery
Military Medicine, 2015
Given the changing epidemiology of infecting pathogens in combat casualties, we evaluated bacteria and fungi in acute traumatic wounds from Afghanistan. From January 2013 to February 2014, 14 mangled lower extremities from 10 explosive-device injured casualties were swabbed for culture at Role 3 facilities. Bacteria were recovered from all patients on the date of injury. Pathogens recovered during routine patient care were recorded. The median injury severity score was 29, median initial Role 3/4 blood product support was 32 units, and median evacuation time was 42 minutes to first surgical care. Gram-positive bacteria were found in some wounds but not methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus. Most wounds were colonized with low-virulence, environmental gram-negative bacteria, and not recovered again during therapy, reflecting wound contamination. Only one wound had the same bacteria (E. cloacae) throughout care at the Role 3, 4, and 5 facilities. Three cultures from two patients had multidrug-resistant bacteria (E. cloacae, E. coli), all detected at Role 5 facilities. Molds were not detected at Role 3, whereas one patient had a mold at Role 4 and 5. Mangled lower extremity injuries have a high contamination rate with environmental organisms, which are not typically associated with infections during the course of the patient's care.
Quantitative bacteriology-A predictor of risk of postoperative infection in open fractures
IP Innovative Publication Pvt. Ltd., 2018
Introduction: Quantitative Microbiology involves measurement of an absolute quantity of bacteria per unit of volume. The threshold to distinguish colonisation from infection is 105 CFU/g. Quantitative cultures are used in predicting the risk of post operative infection. Aim: To determine the role of quantitative bacteriology as a predictor of risk of infection in patients with open fractures. Materials and Methods: One hundred patients who had sustained open fractures of long bones were included in the study. During debridement before antiseptic wash, a piece of tissue (muscle/skin) was collected under aseptic precautions for quantitative culture. A quantitative count of ? 104cfu/gm was interpreted as significant microbial burden. These patients were followed up for 6 weeks for development of clinical signs of infection and two swabs were collected by Levine’s technique for semiquantitative culture. Results: The preoperative culture of the debrided tissue of 41% yielded a microbial load of ?104 cfu/gram among which 85.3% had 105 cfu/gram of microbial load. Polymicrobial growth was reported in 12.2% of patients. Postoperatively 39% developed signs of infection Seventy one percent of patients with 105 cfu/gram of microbial load in the preoperative period developed postoperative infection. All patients with polymicrobial growth in the preoperative debridement cultures with ?104 cfu/gm of microbial load, developed infection in the postoperative period. Conclusion: Quantitative Microbiology plays a precise role in predicting the risk of infection as it is valuable in estimating the bacterial bioburden. Polymicrobial etiology can lead to clinical infection if not managed effectively. Keywords: Quantitative, Infection, Bioburden, Fracture, Debridement.
Current Concept Review: Risk Factors for Infection Following Open Fractures
Orthopedic Research and Reviews
Infection following open fracture is a significant source of morbidity and mortality. Therefore, a central tenet of treatment is to minimize the risk of infection. The initial risk of infection is determined by wound characteristics, such as size, soft tissue coverage, vascular injury, and contamination. While no consensus exists on optimal antibiotic regimen, early administration of prophylactic antibiotics, within an hour of injury, when possible, has been shown definitively to decrease the risk of infection. Infection risk is further reduced by early irrigation with normal saline and aggressive debridement of devitalized tissue. Patient factors that increase risk of infection following open fracture include diabetes mellitus, smoking, male gender, and lower extremity fracture.
Bacterial Spectrum and Antibiotic Sensitivity in open Fractures of the Extremities
Pakistan Journal of Medical and Health Sciences
Background: Open fractures account for around 3 - 4% of all fractures, and infection caused by deprivation of bone and soft tissue, as well as loss of skeletal stabilization, is a serious consequence, particularly in grade III open fractures. Objective: To determine bacterial spectrum and antibiotic sensitivity in open fractures of the extremities Methodology: The current study was descriptive cross sectional study carried out at the department of Orthopedic Surgery, Khyber Teaching Hospital Peshawar for duration of six months from July 2021 to January 2022. All the samples were sent to the hospital diagnostic lab for bacterial identification and antibiogram assay. Kirby- Bauer method was used for antibiogram assay. The data was analyzed by using IBM SPSS version 19.0. Results: A total of 210 patients were included in our study. Male patients were 168(80%) and female were 42(20%). The major cause of fracture was traffic accident observed in 168 (80%) patients. Positive culture repor...