Risk Factors for Infections after Open Fractures - Opportunities for Improving Prophylactic Antimicrobial Therapy
Methods: A retrospective medical record review of hospitalized-patients, ≥18 years diagnosed with open fracture from 12/2011-7/2012 at Palmetto Health Richland,a Level 1 Trauma Center in Columbia, SC. The aim is to compare open fractures by infection status (infected, not infected) and determine factors associated with increasing and mitigating infection, particularly to determine the efficacy of our current antibiotic prophylaxis guidelines.
Results: 80 patients with OF were included. The average age at injury was 38.5 years. The majority were male (75%) and nonwhite (56%). Motor vehicular collision was the most frequent cause of injury (41%). 14 patients developed osteomyelitis. Compared to those who did not develop infection, individuals who developed an infection were more likely to have a tibia/fibula fracture (57% versus 22% p = .03), grade IIIb fracture (19% versus 7% p <.001), visible wound contamination (64% versus 23%, p = .002) and previous hardware (21% vs 5%, p = .03). Compared to those who did not develop infection, those with infection were taken to the operating room sooner (mean 8 hours versus 26 hours, p =.03) and had placement of hardware sooner (mean 8 hours versus 26 hours, p = .02). There was no difference in the duration of prophylactic antibiotics. Compared with other prophylactic antibiotic combinations, individuals who developed an infection were more likely to receive peri-operative gentamicin (64% versus 26%, p =.006) along with cefazolin (100% vs 77%, p =.04). The average time to developing an infection was 54 days. Gram negative (GN) rods were the most common organism isolated. Individuals with infections required an average of 4 additional surgical procedures (range 2-10).
Conclusion: Grade III B open fractures of the lower extremity with visible contamination were more likely to develop osteomyelitis after initial surgery. Findings suggest that more effective GN antimicrobial coverage should be included in the initial peri-operative period for high risk patients.
K. Sanasi- Bhola,
J. Horvath, None
R. Berdel, None
S. Albrecht, None
M. Whitmire, None
D. Parker, None
H. Albrecht, None