Factors associated with surgical site infection in blast-induced traumatic brain injury

Tunthanathip, Thara; Tepaamondej, Nantaka

doi:10.1097/cm9.0000000000000470

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…The most common pathogens that cause nosocomial infections in TBI patients are opportunistic Gram-negative bacteria such as Klebsiella pneumoniae, and Grampositive Staphylococcus aureus [17][18][19][20]. K. pneumoniae is commonly detected in ventilator-associated pneumonia, where it causes severe acute lung damage and inflammation leading to respiratory failure in immunocompromised patients, including those with a TBI or spinal cord injury [21][22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

Modelling lung infection with Klebsiella pneumoniae after murine traumatic brain injury

Shad,

Rewell,

Macowan

et al. 2024

J Neuroinflammation

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Pneumonia is a common comorbidity in patients with severe traumatic brain injury (TBI), and is associated with increased morbidity and mortality. In this study, we established a model of intratracheal Klebsiella pneumoniae administration in young adult male and female mice, at 4 days following an experimental TBI, to investigate how K. pneumoniae infection influences acute post-TBI outcomes. A dose-response curve determined the optimal dose of K. pneumoniae for inoculation (1 x 10^6 colony forming units), and administration at 4 days post-TBI resulted in transient body weight loss and sickness behaviors (hypoactivity and acute dyspnea). K. pneumoniae infection led to an increase in pro-inflammatory cytokines in serum and bronchoalveolar lavage fluid at 24 h post-infection, in both TBI and sham (uninjured) mice. By 7 days, when myeloperoxidase + neutrophil numbers had returned to baseline in all groups, lung histopathology was observed with an increase in airspace size in TBI + K. pneumoniae mice compared to TBI + vehicle mice. In the brain, increased neuroinflammatory gene expression was observed acutely in response to TBI, with an exacerbated increase in Ccl2 and Hmox1 in TBI + K. pneumoniae mice compared to either TBI or K. pneumoniae alone. However, the presence of neuroinflammatory immune cells in the injured brain, and the extent of damage to cortical and hippocampal brain tissue, was comparable between K. pneumoniae and vehicle-treated mice by 7 days. Examination of the fecal microbiome across a time course did not reveal any pronounced effects of either injury or K. pneumoniae on bacterial diversity or abundance. Together, these findings demonstrate that K. pneumoniae lung infection after TBI induces an acute and transient inflammatory response, primarily localized to the lungs with some systemic effects. However, this infection had minimal impact on secondary injury processes in the brain following TBI. Future studies are needed to evaluate the potential longer-term consequences of this dual-hit insult.

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Section: Introductionmentioning

confidence: 99%

Modelling lung infection with Klebsiella pneumoniae after murine traumatic brain injury

Shad,

Rewell,

Macowan

et al. 2024

J Neuroinflammation

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“…In surgical treatment, any foreign material can increase the risk of infection [ 6 ]. In trauma surgery, 1–2% are surgical site infections [ 7 , 8 ]. However, depending on the site of infection, a 55% risk for mortality is reported [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Complication and Infection Risk Using Bone Substitute Materials to Treat Long Bone Defects in Geriatric Patients: An Observational Study

et al. 2023

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Background and Objectives: he treatment of large bone defects in geriatric patients often presents a major surgical challenge because of age-related bone loss. In such patients, the scarcity of healthy makes autologous grafting techniques hard to perform. On the one hand, clinicians’ fear of possible infections limits using bone substitute materials (BSM). On the other hand, BSM is limitless and spares patients another surgery to harvest autologous material. Materials and Methods: To address the aptness of BSM in geriatric patients, we performed a retrospective analysis of all patients over the age of 64 years who visited our clinic between the years 2011–2018. The study assessed postoperative complications clinically and healing results radiologically. The study included 83 patients with bone defects at the distal radius, proximal humerus, and proximal tibia. The defect zones were filled with BSM based on either nanocrystalline hydroxyapatite (NHA) or calcium phosphate (CP). For comparison, a reference group (empty defect, ED) without the void filling with a BSM was also included. Results: 106 patients sustained traumatic fractures of the distal radius (71.7%), proximal humerus (5.7%), and proximal tibia (22.6%). No difference was found between the BSM groups in infection occurrence (p = 1.0). Although not statistically significant, the BSM groups showed a lower rate of pseudarthrosis (p = 0.09) compared with the ED group. Relative risk (RR) of complications was 32.64% less in the BSM groups compared with the ED group. The additional beneficial outcome of BSM was demonstrated by calculating the number needed to treat (NNT). The calculation showed that with every six patients treated, at least one complication could be avoided. Radiological assessment of bone healing showed significant improvement in the bridging of the defect zone (p < 0.001) when BSM was used. Conclusions: In contrast to previous studies, the study showed that BSM could support bone healing and does not present an infection risk in geriatric patients. The NNT calculation indicates a wider potential benefit of BSM.

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“…Surgical side infection in trauma surgery is reported with a mean of 1%-2%. A range of 0.5% to 8.0% is demonstrated in the most trials [7,8]. Concerning side infection, a high risk for mortality (55%) is reported [9].…”

Section: Introductionmentioning

confidence: 99%

Complication and Infection Risk Using Bone Substitute Materials to Treat Long Bone Defects in Geriatric Patients– An Observational Study

Pawelke¹,

Vinayahalingam²,

Khassawna³

et al. 2023

Preprint

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When bone substitutes materials are used, the increased risk of infection due to the none-autogenic graft is often discussed. The treatment of large bone defects in geriatric patients, often with osteoporotic bone, often presents major challenges to surgery. Bone substitutes materials are available indefinitely without the risk of additional surgery in each patient. Can bone substitutes materials be used without hesitation in the geriatric patient? Eighty-three patients suffered traumatic fractures of the distal radius, proximal humerus, and proximal tibia. The defect zones were filled with bone substitute material based on nanocrystalline hydroxyapatite (NHA) or calcium phosphate (CP). For comparison, a reference group without the void filling with a bone graft substitute (void defects, ED) was studied. All patients over the age of 64 years were retrospectively evaluated for complications and radiological outcomes. Results: 106 patients sustained traumatic fractures of the distal radius (68.9%), proximal humerus (5.7%), and proximal tibia (22.6%). No differences in infections were found when comparing the groups (p=1.0). retrospectively evaluated. The KEM group had a nonsignificantly lower rate of pseudarthrosis (p=0.09). A relative risk (RR) reduction of complications of 32.64% was observed when bone grafting material was used. The NNT for the prevention of complications was 5.99. When bone healing was assessed by radiological images, some follow-up studies showed significant differences in fracture bridging (p<0.001). Conclusions: In contrast to previous studies, bone substitutes materials can support the healing process in geriatric patients without relevant disadvantages. With an NNT of 6 regarding complications, many patients could benefit from bone graft augmentation. No increased infection rate was observed.

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Factors associated with surgical site infection in blast-induced traumatic brain injury

Cited by 4 publications

References 8 publications

Modelling lung infection with Klebsiella pneumoniae after murine traumatic brain injury

Modelling lung infection with Klebsiella pneumoniae after murine traumatic brain injury

Complication and Infection Risk Using Bone Substitute Materials to Treat Long Bone Defects in Geriatric Patients: An Observational Study

Complication and Infection Risk Using Bone Substitute Materials to Treat Long Bone Defects in Geriatric Patients– An Observational Study

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