A Descriptive Study of Open Fractures Contaminated by Seawater: Infection, Pathogens, and Antibiotic Resistance

Abstract

Aims. In this work, the main objectives were to investigate the clinical characteristics and bacterial spectrum present in open fractures contaminated by seawater. Methods. We conducted a retrospective cohort study and included all patients with open fractures from 1st January, 2012, to 31st December, 2015, in our hospital. Patients were grouped based on the presence of seawater contamination in wounds. We compared the infection rate, bacterial spectrum, and antibiotic resistance between the two groups. Results. We totally included 1337 cases of open fracture. Wounds from 107 cases (8.0%) were contaminated by seawater. The wound infection rate of seawater-contaminated group was significantly higher in patients with Gustilo-Anderson Type II and Type III open fractures. The bacterial spectrum from seawater-contaminated wounds was remarkably different from that of the remaining. Antibiotic sensitivity tests revealed that more than 90% of infecting pathogens in seawater-contaminated wounds were sensitive to levofloxacin and ciprofloxacin. Conclusion. Cephalosporin in combination with quinolone was recommended in the early-stage management of open fractures contaminated by seawater.

Therapeutic effect of ethylenediaminetetraacetic acid irrigation solution against wound infection with drug-resistant bacteria in a rat model: an animal study

“…25 EDTA was more effective than NS solution in a rat wound model infected with seven of the most commonly isolated pathogens, which represent more than 90% of causative strains. 33 Furthermore, we showed that EDTA solution was also superior to castile soap, benzalkonium chloride, and bacitracin. PJI remains a great challenge to the orthopaedic community.…”

“…36 Pathogens such as MRSA, ESBL-EC, MRPA, VRE, MRAB, MRE, and MRPM have been found to be the most frequent drug-resistant strains isolated from infected open fractures. 33 Although many novel antimicrobials have been established in recent decades, management of wound infection by these bacteria has been increasingly challenging. 37 Irrigation and debridement of wounds remains the cornerstone to eliminating such infections.…”

“…We chose seven species of bacteria that were responsible for over 90% of wound infections. 33 The following strains of bacteria were obtained from the American Type Culture Collection (ATCC): methicillin-resistant Staphylococcus aureus (MRSA), BAA-1747; extended spectrum beta-lactamase-producing E. coli (ESBL-EC), BAA-196; multidrug-resistant Pseudomonas aeruginosa (MRPA), BAA-2108; vancomycin-resistant Enterococcus (VRE), 51559; multidrug-resistant Acinetobacter baumannii (MRAB), BAA-1605; multidrug-resistant Enterobacter (MRE), BAA-2468; and multidrug-resistant Proteus mirabilis (MRPM), BAA-2791. We maintained a stock culture of these strains of bacteria on tryptic soy agar (TSA) with 5% sheep blood (TSA II; BD GmbH, Heidelberg, Germany), and prepared fresh culture 24 hours before surgery at 37°C and in an aerobic medium (5% CO 2 ).…”

Assessment of seawater bacterial infection in rabbit tibia by Illumina MiSeq sequencing and bacterial culture

“…Moreover, the physical properties of seawater, such as its hypertonic nature, high sodium level, alkalinity, and low temperature, directly affect the species composition. The most commonly observed bacterial infections following an open fracture on land are caused by Pseudomonas aeruginosa , Acinetobacter baumannii, Enterobacter , and methicillin-resistant Staphylococcus aureus, none of which exist in wounds soaked in seawater [ 7 ]. These differences may be attributed to two factors: first, bacterial infections may be associated with differences in the causative species and their quantity, virulence, and invasiveness; second, people living on land for a long time have different body reactions to marine bacteria, in terms of the time, degree, and scope of infection, among others.…”

Preparation of Antimicrobial Hyaluronic Acid/Quaternized Chitosan Hydrogels for the Promotion of Seawater-Immersion Wound Healing

“…With the extensive use of high-tech weapons, especially precision-guided missiles on the battlefield, the trauma and burns caused by high-energy explosion in naval battle have become the most important and challenging healthcare issues (Zhu et al, 2017;Chen et al, 2019). In modern high-tech naval warfare, the unavoidable exposure of open traumas to seawater with high salt, high sodium, and a high abundance of pathogenic bacteria, especially gram-negative bacteria, can cause serious infections and wound-repair difficulties (Zhang et al, 2017).…”