297. Risk Factors for Infections in Open Fractures
Session: Poster Abstract Session: Bone and Joint Infections
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • infections in open fractures. idweek 2018.pdf (129.0 kB)
  • Background: Open fractures are more prone to get infected. Known risk factors are high grade Gustilo and patients' co-morbidities, while early antibiotic administration and surgical debridement decrease the risk of infection. There is little data regarding the preferred antimicrobial therapy, timing, and duration of treatment, especially in the era of antimicrobial resistance. The aim of our study was to compare patients with and without infections after open fractures, and identify risk factors for infections, including timing of antimicrobial first dose and its duration.

    Methods: A historical cohort study was conducted in a secondary hospital. All adult patients admitted to the hospital with an open fracture of the limbs, between 1.1.2012 and 31.12.2016 were included in the study. Epidemiological, clinical and microbiological data was collected and analyzed. Microbiological infection was defined by positive wound cultures during first 30 days, and clinical infection as defined by the treating physician.

    Results: 167 patients were included in the study. 160 patients (95%) were treated with a first generation cephalosporine, and 55 (33%) were also treated with aminoglycosides. Microbiological infection was identified in 12 (7%) patients, and clinical infection in 27 (16%) patients. All patients received the first dose of antimicrobial therapy within 15 hours of admission (median - 1.29 hours). Early administration of the first dose of antimicrobial therapy did not reduce the risk of infection (median of 1.06 hours for patients who developed infection versus 1.31 hours for patients that did not develop infection, p=0.58). Duration of treatment was not correlated to the risk of infection (1-3 days versus 4-7 days, p=0.6). In multivariate logistic regression, only location of fracture in the lower limbs was associated with an increased risk of infection (OR 4.654, CI 1.407-15.398), and Gustilo grade 1 or 2 were associated with decreased risk of infection (OR 0.301, CI 0.104-0.872).

    Conclusion: In our cohort, neither early administration of antimicrobial therapy, nor prolonged duration of treatment, reduced the risk of infection in open fractures.

    Sharon Reisfeld, MD1,2, Islam Labnawi, MD3, Nurit Shadmi, MD3 and Michal Stein, MD1,2, (1)Ruth & Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel, (2)Infectious Diseases Unit, Hillel Yaffe Medical Center, Hadera, Israel, (3)Orthopedic Division, Hillel Yaffe Medical Center, Hadera, Israel

    Disclosures:

    S. Reisfeld, None

    I. Labnawi, None

    N. Shadmi, None

    M. Stein, None

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