Surgical site infection in orthopedic trauma: A case–control study evaluating risk factors and cost

Thakore, Rachel V.; Greenberg, Sarah E.; Shi, Hanyuan; Foxx, Alexandra; Francois, Elvis L.; Prablek, Marc; Nwosu, Samuel K.; Archer, Kristin R.; Ehrenfeld, Jesse M.; Obremskey, William T.; Sethi, Manish K.

doi:10.1016/j.jcot.2015.04.004

Cited by 140 publications

(106 citation statements)

References 24 publications

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“…They also encounter higher direct and indirect health care costs. The results from a recent cost analysis showed that the hospital-related health care costs of infected cases are approximately 6.5-times higher than for non-infected cases, which is much higher than data that were previously published [2–4]. These results stress the importance of standardized prevention and treatment guidelines, with respect to this serious complication.…”

Section: Introductionmentioning

confidence: 91%

Insights into treatment and outcome of fracture-related infection: a systematic literature review

Bezstarosti

Lieshout

Voskamp

et al. 2018

Arch Orthop Trauma Surg

112

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IntroductionStandardized guidelines for treatment of fracture-related infection (FRI) are lacking. Worldwide many treatment protocols are used with variable success rates. Awareness on the need of standardized, evidence-based guidelines has increased in recent years. This systematic literature review gives an overview of available diagnostic criteria, classifications, treatment protocols, and related outcome measurements for surgically treated FRI patients.MethodsA comprehensive search was performed in all scientific literature since 1990. Studies in English that described surgical patient series for treatment of FRI were included. Data were collected on diagnostic criteria for FRI, classifications used, surgical treatments, follow-up protocols, and overall outcome. A systematic review was performed according to the PRISMA statement. Proportions and weighted means were calculated.ResultsThe search yielded 2051 studies. Ninety-three studies were suitable for inclusion, describing 3701 patients (3711 fractures) with complex FRI. The population consisted predominantly of male patients (77%), with the tibia being the most commonly affected bone (64%), and a mean of three previous operations per patient. Forty-three (46%) studies described FRI at one specific location. Only one study (1%) used a standardized definition for infection. A total of nine different classifications were used to guide treatment protocols, of which Cierny and Mader was used most often (36%). Eighteen (19%) studies used a one-stage, 50 (54%) a two-stage, and seven (8%) a three-stage surgical treatment protocol. Ten studies (11%) used mixed protocols. Antibiotic protocols varied widely between studies. A multidisciplinary approach was mentioned in only 12 (13%) studies.ConclusionsThis extensive literature review shows a lack of standardized guidelines with respect to diagnosis and treatment of FRI, which mimics the situation for prosthetic joint infection identified many years ago. Internationally accepted guidelines are urgently required to improve the quality of care for patients suffering from this significant complication.

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Section: Introductionmentioning

confidence: 91%

Insights into treatment and outcome of fracture-related infection: a systematic literature review

Bezstarosti

Lieshout

Voskamp

et al. 2018

Arch Orthop Trauma Surg

112

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“…Surgical site infection (SSI) is one of the most common complications in orthopaedic surgery, and its incidence was reported to vary greatly depending on the definitions of infection, fracture locations and sites, surgical patterns, and the study design. SSIs incresed the possibility of abscess formation, osteomyelitis, and bone union problems, which might have long‐term negative effects on the mobility of the unjured limbs or articular joints .…”

Section: Introductionmentioning

confidence: 99%

“…SSIs incresed the possibility of abscess formation, osteomyelitis, and bone union problems, which might have long‐term negative effects on the mobility of the unjured limbs or articular joints . On the other hand, postoperative SSIs substantially increased the total medical costs because of secondary surgery or antibiotic treatment and prolonged hospitalisation stay by 7 to 14 days . Therefore, identification of the associated risk factors and their use in the comprehensive assessment of patients' susceptibility to SSIs, thereby screening patients at risk, could be a simple and cost‐effective measure to reduce or prevent SSI occurrence.…”

Section: Introductionmentioning

confidence: 99%

“…6 On the other hand, postoperative SSIs substantially increased the total medical costs because of secondary surgery or antibiotic treatment and prolonged hospitalisation stay by 7 to 14 days. 4,7 Therefore, identification of the associated risk factors and their use in Kaosheng Lu and Jixin Zhang contributed equally to this study. the comprehensive assessment of patients' susceptibility to SSIs, thereby screening patients at risk, could be a simple and cost-effective measure to reduce or prevent SSI occurrence.…”

mentioning

confidence: 99%

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Incidence and risk factors for surgical site infection after open reduction and internal fixation of intra‐articular fractures of distal femur: A multicentre study

Zhang²,

Cheng

et al. 2018

International Wound Journal

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There remains a lack of data on the epidemiological characteristics of surgical site infection (SSI) following the open reduction and internal fixation (ORIF) of intra‐articular fractures of distal femur, and the aim of this study was to solve this key clinical issue. The electronic medical records (EMRs) of patients who underwent ORIF for distal femoral fracture from January 2013 to December 2017 were reviewed to identify those who developed a SSI. Then, we conducted univariate Chi‐square analyses and used a multivariate logistic regression analysis model to determine the adjusted risk factors associated with SSI. A total of 724 patients who underwent ORIF of intra‐articular fractures of the distal femur were studied retrospectively, and 29 patients had postoperative SSIs. The overall incidence of SSIs was 4.0% (29/724), with deep SSIs being 1.5% (11/724), and superficial SSIs being 2.5% (18/724). Staphylococcus aureus was the most common causative pathogen (8, 42.1%), followed by mixed bacterial pathogens (5, 26.3%). Open fracture, obesity, smoking, and diabetes mellitus were identified as the adjusted risk factors associated with SSIs. Although modification of these risk factors may be difficult, patients and families should be counselled regarding their increased risk of SSI because these patients potentially benefit from focused perioperative medical optimisation.

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“…The incidence of infection after internal fixation of closed fractures is reported to be 1-2% but can reach 30% in cases of open fractures [5][6][7]. As the consequences of such infection can be life-changing for the patient due to permanent functional loss or amputation of the affected limb, patient quality of life (QoL) and functional status also decrease [8][9][10]. To tackle these issues, it seems highly important to focus on infection prevention and improve outcome.…”

Section: Introductionmentioning

confidence: 99%

Prevention of fracture-related infection: a multidisciplinary care package

Metsemakers

Onsea

Neutjens

et al. 2017

International Orthopaedics (SICOT)

100

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Fracture-related infection (FRI) remains a challenging complication. It may result in permanent functional loss or even amputation in otherwise healthy patients. For these reasons, it is important to focus attention on prevention. In treatment algorithms for FRI, antibiotic stewardship programmes have already proved their use by means of a multidisciplinary collaboration between microbiologists, surgeons, pharmacists, infectious disease physicians and nursing staff. A similar approach, however, has not been described for infection prevention. As a first step towards achieving a multidisciplinary care package for infection prevention, this review summarises the most recent guidelines published by the World Health Organization (WHO) and US National Institutes of Health Centers for Disease Control and Prevention (CDC), primarily focusing on the musculoskeletal trauma patient. The implementation of these guidelines, together with close collaboration between infection control physicians, surgeons, anaesthesiologists and nursing staff, can potentially have a beneficial effect on the rate of FRI after musculoskeletal trauma surgery. It must be stated that most evidence presented here in support of these guidelines was not obtained from musculoskeletal trauma research. Although most preventive measures described in these studies can be generalised to the musculoskeletal trauma patient, there are still important differences with nontrauma patients that require further attention. Future research should therefore focus more on this very defined patient population and more specifically on FRI prevention.

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Surgical site infection in orthopedic trauma: A case–control study evaluating risk factors and cost

Cited by 140 publications

References 24 publications

Insights into treatment and outcome of fracture-related infection: a systematic literature review

Insights into treatment and outcome of fracture-related infection: a systematic literature review

Incidence and risk factors for surgical site infection after open reduction and internal fixation of intra‐articular fractures of distal femur: A multicentre study

Prevention of fracture-related infection: a multidisciplinary care package

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