Early infectious outcomes after addition of fluoroquinolone or aminoglycoside to posttrauma antibiotic prophylaxis in combat-related open fracture injuries

Ba, Lloyd; Ck, Murray; F, Shaikh; Ml, Carson; Dm, Blyth; Er, Schnaubelt; Tj, Whitman; Dr, Tribble

doi:10.1097/ta.0000000000001609

Cited by 27 publications

(16 citation statements)

References 23 publications

(35 reference statements)

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“…They reported that there was no significant difference between treatments and the rate of infection. Lloyd et al reported that the infection rate was slightly decreased when antibiotics specifically targeting Gram-negative bacteria were selected; however, there were no significant differences in the rate of osteomyelitis [27]. Based on these results, the authors recommended cefazolin or clindamycin in open fractures.…”

Section: Table 3 Comparison Of Fractures With and Without Infectionmentioning

confidence: 99%

Retrospective analysis of risk factors for deep infection in lower limb Gustilo–Anderson type III fractures

et al. 2020

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Background: Open fractures are among the most severe injuries observed in orthopedic patients. Treating open fractures is difficult because such patients with infections may require multiple operations and amputations. Furthermore, only a few studies have focused on antibiotic prophylaxis in open fractures and evaluated how to cover lost soft tissue to increase the success rate of reconstruction. We evaluated the risk factors for deep infection in lower limb Gustilo-Anderson (G-A) type III fractures. Materials and methods: This retrospective study investigated patients who underwent surgical procedures for lower limb G-A type III fractures between January 2007 and January 2017 at our institution. We enrolled 110 patients with 114 lower limb G-A type III fractures (77 G-A type IIIA fractures and 37 G-A type IIIB fractures) who were followed up for at least 2 years. We compared patients presenting infections with those without infections by assessing the following factors: severe contamination, diabetes, smoking, Injury Severity Scale, segmental fracture, location of fracture, G-A classification, damage control surgery, methods of surgery, timing of fixation, combination of antibiotics used, duration of antibiotic prophylaxis, timing of wound closure, and soft-tissue reconstruction failure. Results: Eighteen fractures presented deep infections. Compared with patients without infections, patients developing infections differed significantly in terms of severe contamination (P < 0.01), G-A classification (P < 0.01), duration of antibiotic prophylaxis (P < 0.01), timing of wound closure (P < 0.01), and incidence of soft-tissue reconstruction failure (P < 0.01). Skin grafting was associated with significantly higher failure rates than muscle and free flap reconstructions (P = 0.04). Treatment with antibiotics was significantly longer in patients with drug-resistant bacterial infections than in those without infections (P < 0.01). Conclusion: Early flaps rather than skin grafting should be used to cover G-A type IIIB fractures, because skin grafting resulted in the highest failure rate among soft-tissue reconstructions in open fractures. Longer duration of antibiotic use had a significant impact not only on deep infection rates but also on the presence of drug-resistant bacteria. These findings suggest that prolonged use of antibiotics should be avoided in cases of open fractures.

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Section: Table 3 Comparison Of Fractures With and Without Infectionmentioning

confidence: 99%

Retrospective analysis of risk factors for deep infection in lower limb Gustilo–Anderson type III fractures

et al. 2020

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“…The United States and European countries, starting from the first intervention in the field, can perform transport, first surgical interventions, and then definitive procedures and treatments of their injured military personnel under better conditions. This leads to better outcomes (3,15). On the other hand, in studies of the Sudanese and Syrian civil wars, infection, morbidity, and mortality rates are seen to be higher.…”

Section: Discussionmentioning

confidence: 99%

Treatment of sepsis secondary to blast injuries

2021

jsurgarts

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Blast injuries are an important cause of morbidity and mortality due to ongoing conflicts, especially among young patients. Due to the adversities of warfare, the first interventions for these patients are performed in unsuitable environments. Patients generally do not receive further treatment in their own country, but in other countries as wounded war refugees. Local and systemic infections in patients with associated polytrauma, soft tissue damage, and blast effects cause mortality and morbidity. All of the patients were injured during the Libyan civil war and the first intervention was performed in hospitals in their own country or in Tunisia. The patients were transferred to our clinic by ambulance plane. All patients presented bone-soft tissue infection and sepsis. Bone-soft tissue and blood cultures were obtained from the patients. The first interventions for the patients were performed multidisciplinarily in orthopedics, general surgery, infection, and intensive care clinics. The patients were followed in our clinic for one year including inten-sive care, service, and outpatient monitoring. Sixteen patients with a mean age of 28.8 years were included in the study. All patients were wounded by explosives or missiles. The patients were admitted to our clinic at a mean of approximately 24.4 days after these events. The patients were followed in the intensive care unit for an average of 7.9 days. The mean follow-up was 4 months. After the service follow-up, each patient continued outpatient follow-up for a total of 12 months. Antibiotics were given according to the causative infectious agent during the intensive care and service follow-up. Three patients had lung infections. Colistin-induced renal failure or hepatotoxicity developed due to resistant infections in 4 patients. After colistin was ceased, this situation resolved. Two of the 16 patients died. The sepsis and bone-soft tissue infections were controlled in all other patients. Four patients had femoral nonu-nion and one patient had short femoral healing. While 2 patients were able to walk without support and 11 patients could walk using support and one patient who was Quadriplegic was unable to walk. The treatment of bone-soft tissue infections accompanied by sepsis should be multidisciplinary. This should be kept in mind for patients with systemic injuries due to explosion effects. The infectious agents in these patients are often drug-resistant and there may be complications secondary to the antibiotics used during treatment.

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“…13 Patients with open extremity fractures were excluded from this analysis and assessed separately. 14 Data were collected as part of the Trauma Infectious Disease Outcomes Study (TIDOS), which is an observational, multisite cohort study implemented to examine the short- and long-term infectious complications related to deployment-related traumatic injuries. 13 This study was approved by the Infectious Disease Institutional Review Board of the Uniformed Services University of the Health Sciences (Bethesda, MD).…”

Section: Methodsmentioning

confidence: 99%