Epidemiology of Bacterial Infection During Management of Open Leg Fractures

Abstract

In a randomised double-blind trial conducted between 1990 and 1994, 616 patients from 43 centres, pefloxacin (group P, 316 patients) and a cefazolinoxacillin combination (group C, 300 patients) were compared in the prophylaxis of bone infection after grade 1 and 2 open leg fractures. Samples were obtained at emergency, before and during surgery, and from drain aspirates. Antimicrobial susceptibility, slime production and adherence properties of the bacteria were tested. Cultures at emergency and before surgery showed similar distributions of gram-positive and gram-negative bacteria in both groups, while wound closure and infecting isolates showed prevailing gram-positive bacteria in group P and gram-negative bacteria in group C. Positive cultures at each stage were correlated with the occurrence of infection but were not predictive of the infecting species, which were nosocomial bacteria in most cases. Positive cultures at wound closure warn of a higher infection risk. Twenty-one of 316 (6.6%) patients in group P and 24 of 300 (8%) in group C were considered infected within 3 months. The difference is not significant (chi-square test p0.42; Pp0.51). Infecting strains were isolated from 38 patients (group P, 18; group C, 20). Infecting species,although not predictable, appear to be those escaping the spectrum of the prescribed antimicrobial prophylaxis.

Perioperative Antibiotikaprophylaxe bei aseptischen Knochen- und Gelenkeingriffen

“…In randomized studies, the incidence of infection after intramedullary fixation of closed tibial fractures reached 1.3% (95% CI 0.3-7.1%); in a meta-analysis, no difference could be found between reamed and unreamed nailings (risk ratio [RR] 0.98, 95% CI 0.21-4.76, risk difference [RD] -0.4%, 95% CI -3-2%) [1]. As it has to be expected, the incidence of infection after open injuries is higher (7.3%, 95% CI 5.4-9.7%) [2].…”

“…Nach offenen Verletzungen liegen die Infektionsraten erwartungsgemäß höher (7,3%, 95%-CI 5,4-9,7%) [2]. Aus Fallserien der Jahre 1943-1979 wurden von 23 538 Patienten kumulative Inzidenzen zwischen 0,2% (95%-CI 0,0-0,5%) und 17,7% (95%-CI 0,0-35,8%) berichtet [22].…”

Posttraumatic Bacterial Infections in Extremities before and after Osteosynthesis in Small Animals

“…and Klebsiella spp. (Hirsch and Smith 1978 (Calza et al 2001) and also Pseudomonas aeruginosa (Carsenti-Etesse et al 1999, Greenberg et al 2000, Calza et al 2001, S hirliff et al 2002.…”

Negative Pressure Wound Therapy in Grade IIIB Tibial Fractures: Fewer Infections and Fewer Flap Procedures?

“…The question was whether use of negative pressure wound therapy beyond 72 hours would result in increased infection rates compared with historic controls [1,11,13,20,26,28]. Reported infection rates are highly variable for Grade IIIB tibia wounds with the upper end at 67% [10]. Eight [15,16,30,33,35,36,47,50] of the 10 studies with data regarding extended use of negative pressure wound therapy reported infection rates comparable to historic rates or lower.…”

“…The implant used for bony stabilization may compromise regional bone blood flow and may lead to wound problems [55]. These factors and others contribute to wound-bed bacterial colonization [10,12,14,27,46,54,55] and progression to infection. Since Godina's study [25], it generally has been accepted that these open fractures require early (within 72 hours) bony stabilization and soft tissue reconstruction.…”