1511. Osteomyelitis after Open Fractures Adjusting  Prophylactic Antimicrobial Therapy
Session: Poster Abstract Session: Clinical Infectious Diseases: Osteomyelitis
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • Osteomyelitis after open fractures.pdf (337.0 kB)
  • Background: Current peri-operative antibiotic prophylaxis for preventing open fractures (OF) associated osteomyelitis (OM) may not cover a significant proportion of eithiologic agents. This study retrospectively reviewed in-vitro antimicrobial susceptibilities of the organisms from OF-associated OM.

    Methods: Hospitalized adults with OF from 12/2011-12/2012 at  a Level 1 Trauma Center in Columbia, SC, were identified. In vitro antimicrobial susceptibility of pathogens causing OM to currently recommended prophylactic cefazolin(cef) plus gentamicin (gent) for high-grade  OF was compared to other potential prophylactic regimens.

    Results: A total of 174 patients with OF were included, including 46 who developed subsequent OM. The majority were non-white (54%), males (71%), with OF in the lower extremities (78%). Individuals who developed OM were more likely to have a IIIB OF (43% vs 13%, p=<0.001) with visible contamination (43% vs 17%, p<0.001). The incidence proportion of developing OM with low grade (≤ II) fractures was 0.13 (13/97) and that for high grade (≥III) OF was 0.43 (33/77).

    The majority of patients (44/46) received cef at time of initial injury and 28/33 with high grade OF received additional GN coverage (22 gent, 2 piperacillin/tazobactam, 2 aztreonam, 1 ceftazadime and 1 ciprofloxacin).

    Overall gram negative bacilli were the most common causative organisms of OM after high grade OF (27/41 isolates) including 10 potential chromosomally-mediated AmpC-producing Enterobacteriaceae (6 Enterobacter spp  and 4 Serratia spp) and 6 Pseudomonas aeruginosa isolates. The remaining pathogens included 14 gram positive organisms (4 methicillin-resistant staphylococci, 6 methicillin-susceptible staphylococci, 3 Enterococcus spp and 1 bacillus spp) and 1 Candida albicans.  

    74% of these organisms were susceptible to current antibiotic prophylaxis regimen, gent and cef. Cefepime, piperacillin/tazobactam and ciprofloxacin would provide coverage for 77%, 74 % and 84% of OM organisms, respectively. Addition of vancomycin would provide additional GP coverage particularly methicillin-resistant staphylococci.

    Conclusion: Based on the above results, a powerplan was formulated using ciprofloxacin and vancomycin in an attempt to minimize the risk of OF-associated OM  and  limit  unnecessary broad-spectrum beta-lactams.

    Kamla Sanasi-Bhola, MD1, Majdi Al-Hasan, MD2, Sharon Weissman, MD1, Helmut Albrecht, MD2, Rebecca Berdel, MD3, Stephan Albrecht, BS4, Medha Iyer, M.D., Ph.D.5 and Joseph Horvath, MD6, (1)Medicine, University of South Carolina, Columbia, SC, (2)Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine, Columbia, SC, (3)University of South Carollina, Columbia, SC, (4)University of South Carolina, Columbia, SC, (5)Department of Health Services Policy and Management, University of South Carolina,Arnold School of Public Health, Columbia, SC, (6)Infectious Disease, University of South Carolina, Columbia, SC

    Disclosures:

    K. Sanasi-Bhola, None

    M. Al-Hasan, None

    S. Weissman, None

    H. Albrecht, Gilead: Investigator and Scientific Advisor , Research grant

    R. Berdel, None

    S. Albrecht, None

    M. Iyer, None

    J. Horvath, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.