Wound Infection Rates After Invasive Procedures in HIV-1 Seropositive Versus HIV-1 Seronegative Hemophiliacs

Abstract

One-hundred and two patients with hemophilia A, hemophilia B, or acquired antibody to factor VIII who had undergone invasive procedures were cross referenced with patients participating in an ongoing prospective natural history study of HIV-1 infection in hemophiliacs. Matching revealed that HIV-1 status was known for 83 patients (83%) who had undergone 169 procedures between July 1979 and April 1988. Invasive procedures were classified as clean in 108 patients (63.9%), clean-contaminated in 45 (26.6%), contaminated in 2 (1.2%), and infected in 14 (8.3%). Wound infection rates by HIV-1 status were as follows (95% confidence intervals): HIV+ 1.4% (0% to 5%), HIV- 0% (0% to 9%), and procedure before testing HIV+ 1.5% (0% to 6%). There were no significant differences between the wound infection rates of HIV-positive and HIV-negative hemophiliacs nor in the wound infection rate among all three subgroups of patients (p greater than 0.5, Fisher's Exact Test). We conclude that surgery in HIV-1-infected patients who have not progressed to AIDS does not entail an increased risk of postoperative wound infections.

The Role of Prophylactic Antibiotics in Elective Hand Surgery

“…24 Evidence has shown that wound healing is not clinically impaired in patients with asymptomatic human immunodeficiency virus infection. 51,52 Wound healing in patients with acquired immune deficiency syndrome may be impaired but the cause is not definitively known. 24 Wound infections in these patients should be responsive to conventional therapy.…”

Acute Abdomen and HIV Infection

“…On the other hand, delayed diagnosis and late surgical exploration result in increased morbidity and mortality 5 . Although profound immunodeficiency is associated with poor prognosis, asymptomatic HIV-infected patients recover well from surgery and do not appear to suffer delayed healing 6,7 . Yet, with new antiviral therapy the operative mortality has dropped as much as necessary for emergency abdominal surgery and the riskbenefit analysis is now more in favour of laparotomy 5,8,9 .…”

One-year follow-up of orthopaedic implants in HIV-positive patients

“…Information about early sepsis after implant surgery is becoming available [1,3,5,6,8,9,11,12], but evidence about late sepsis is required for appropriate decisionmaking. In the case of arthroplasty, the principal benefit may be lost if the implant is removed, whereas in the case of implants for fracture fixation or arthrodesis, removal after bony union has occurred is not detrimental.…”