The Socioeconomic Impact of Musculoskeletal Infections

Poultsides, Lazaros; Liaropoulos, Lycourgos; Malizos, Konstantinos N.

doi:10.2106/jbjs.i.01131

Cited by 102 publications

(71 citation statements)

References 118 publications

(124 reference statements)

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“…The incidence of post-traumatic osteomyelitis is rising in our setting because of the increase in frequency of road traffic accidents and the development of orthopaedic procedures. However, osteomyelitis is a serious and invalidating illness characterised by a high rate of treatment failures and often requires long periods of treatment and hospitalisation leading to temporary impairment and at times long lasting disability or even permanent handicaps [2] . Treatment comprises of surgical debridement of all necrotic bone and soft tissue along with use of appropriate antimicrobial therapy.…”

Section: Introductionmentioning

confidence: 99%

Clinical and microbiological profile of post-traumatic osteomyelitis in tertiary hospital in Yaoundé –Cameroon

Ed¹,

Aa²,

Kh³

et al. 2017

Int. J. Orthop. Sci.

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Background: Post-traumatic osteomyelitis is bone infection secondary to a trauma (open fracture or bone surgery). It is a painful and frustrating disease characterised by a high rates of therapeutic failures and a costly management. However, treatment is increasingly becoming difficult because of the phenomenon of antibiotic resistance. The present study was realised to determine the epidemiological and susceptibility profile of bacterial isolates in posttraumatic osteomyelitis in a tertiary hospital in the city of Yaoundé. Method: A descriptive cross-sectional study was carried out between November 2016 and May 2017. Patients admitted for post-traumatic osteomyelitis were recruited. After recoding clinical informations, deep specimens were taken during surgical debridement and were cultured in Blood, Mannitol Salt and MacConkey plates at 37 o C for 24-72hrs. Culture isolates were identified by standard biochemical reactions. Antibiotic susceptibility was performed by Kirby-Bauer method using the CASFM guidelines. Results: A total of 31 patients were recruited; the modal age range was 21-50 years (67.8%) and the sex ratio 1.8:4. The commonest bones affected were the tibia (48.5%) and femur (32.3%). Predisposing factors identified included open fractures (76%), delay surgical debridement (83.3%), presence of prosthesis (58%) and surgical wound infections (23%). Out of 31 samples, 29 yielded positive culture giving rise to 48 bacteria isolates. Fourteen samples (48%) were polybacterial. The most predominant species was Escherichia coli (29%), followed by Staphylococcus aureus, Pseudomonas aeruginosa and Klebsiella pneumoniae (all 22.6%). The Gram positive organisms showed good sensitivity to Imipenem, Rifampicin, Fucidine, Lincomycin, and to Vancomycin whereas the Gram negative bacilli were mostly sensitive to Imipenem (96.7%), Amikacin (82.1%) and to a lesser extend Quinolones (54%) and Piperacillin/Tazobactam and Ceftazidime (48%). Conclusion: Nosocomial bacteria dominate the bacterial flora of posttraumatic osteomyelitis in our setting and many multidrug resistant strains are emerging thus emphasizing on the importance of hygiene and targeted antibiotherapy.

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Section: Introductionmentioning

confidence: 99%

Clinical and microbiological profile of post-traumatic osteomyelitis in tertiary hospital in Yaoundé –Cameroon

Ed¹,

Aa²,

Kh³

et al. 2017

Int. J. Orthop. Sci.

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“…4 Postoperative surgical-site infection is a serious complication of total hip and knee arthroplasty, adversely affecting patients while consuming extensive hospital resources. 4,5 The annual incidence of surgical-site infection is estimated to be 1%-2% among patients undergoing total knee arthroplasty and 0.4%-2.5% among those undergoing total hip arthroplasty. 1,2 The cost of a single surgical-site infection associated with total joint arthroplasty represents an average 4-fold increase in cost compared with the primary procedure, with an estimated average cost of US$50 000 per infection.…”

mentioning

confidence: 99%

“…1,4 As the number of primary procedures grows, the burden of surgicalsite infections is expected to increase accordingly. 5,6 Strategies aimed at reducing the incidence and prevalence of surgical-site infections after primary total hip and knee arthroplasty are well documented. 7,8 The use of antibiotic prophylaxis (both intraoperatively and postoperatively) is accepted as the gold standard in orthopedic practice and is recommended by the most widely accepted consensusbased guidelines.…”

mentioning

confidence: 99%

Postoperative antibiotic prophylaxis in total hip and knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

et al. 2015

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Background: Postoperative antibiotic prophylaxis is currently the standard of care for patients undergoing total hip and knee arthroplasty. We evaluated the evidence for this practice in the reduction of surgical-site infections. Methods:We systematically searched MEDLINE, Embase and the Cochrane Library for randomized controlled trials (RCTs) published up to Aug. 15, 2014. We included all RCTs that compared postoperative antibiotic prophylaxis with postoperative placebo or no treatment in patients undergoing primary total hip or knee arthroplasty for osteoarthritis. We combined outcomes for surgical-site infection using a random-effects model and quantified heterogeneity using the χ 2 test and the I 2 statistic. We assessed the overall quality of the evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results:We identified 4 RCTs (n = 4036) that met the inclusion criteria. Surgical-site infections occurred in 3.1% (63/2055) of patients in the prophylaxis group and 2.3% (45/1981) in the control group. Postoperative prophylaxis did not reduce the rate of surgical-site infections compared with placebo (risk difference 0.01, 95% confidence interval 0.00 to 0.02; I 2 = 26%). This result was robust to sensitivity testing for losses to follow-up. According to the GRADE approach, the overall quality of evidence was very low. Interpretation:The available evidence did not show efficacy of postoperative antibiotic prophylaxis for the prevention of surgical-site infections in patients undergoing total hip or knee arthroplasty. Multicentred RCTs are likely to have an important impact on the confidence in the effect estimate and to change the estimate itself. number of primary procedures grows, the burden of surgicalsite infections is expected to increase accordingly. 5,6 Strategies aimed at reducing the incidence and prevalence of surgical-site infections after primary total hip and knee arthroplasty are well documented. 7,8 The use of antibiotic prophylaxis (both intraoperatively and postoperatively) is accepted as the gold standard in orthopedic practice and is recommended by the most widely accepted consensusbased guidelines. [9][10][11] The duration of postoperative antibiotic prophylaxis varies somewhat across these guidelines, from no longer than 24 hours to no longer than 36 hours (Appendix 1, available at www.cmajopen.ca/content/3/3/ E338/suppl/DC1).We conducted a systematic review and meta-analysis to evaluate the evidence for postoperative antibiotic prophylaxis in the reduction of surgical-site infections among patients undergoing primary total hip or knee arthroplasty. MethodsWe followed the protocol outlined in the Cochrane Handbook for Systematic Reviews of Interventions. 12 We report our findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. 13Data sources and study selection We searched MEDLINE (1946 to present), Embase (1974 to present) and the Cochrane Library (no date limit) for art...

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“…Die nosokomiale Infektion ist insbesondere in Unfallchirurgie und Orthopädie ein in Deutschland nicht zu unterschätzendes Problem. Sozioökono-misch belasten postoperative Infektionen das Sozialbudget um hohe Beträge [5,34]. Nach §23 Abs.…”

Section: äTiologieunclassified

Infektionen in Unfallchirurgie und Orthopädie

Dresing

2013

Oper Orthop Traumatol

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The Socioeconomic Impact of Musculoskeletal Infections

Cited by 102 publications

References 118 publications

Clinical and microbiological profile of post-traumatic osteomyelitis in tertiary hospital in Yaoundé –Cameroon

Clinical and microbiological profile of post-traumatic osteomyelitis in tertiary hospital in Yaoundé –Cameroon

Postoperative antibiotic prophylaxis in total hip and knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

Infektionen in Unfallchirurgie und Orthopädie

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