Early Outcome of Culture-Negative Infection in Open Fractures of the Lower Limb: A Prospective Study

Hariharan, T D; Joseph, Christina Marie; Samuel, Sumant; Elangovan, Divyaa; Livingston, Abel; Ramasamy, Boopalan; Nithyananth, Manasseh; Jepegnanam, Thilak Samuel

doi:10.4103/ijmm.ijmm_19_143

Cited by 4 publications

(1 citation statement)

References 16 publications

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“…Regardless of the detection method used, bacterial culture results may be negative. Hariharan (12) and Gitajn (13), et al showed that about 9-17% of patients with post-traumatic fracture infections have negative bacterial cultures. Agostino et al (9) analyzed the in uence of different methods on the bacterial detection rate after spinal infection.…”

Section: Diagnosismentioning

confidence: 99%

Adjacent segment infection after posterior lumbar fusion surgery

Bao,

Han,

Chen

et al. 2023

Preprint

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Study Design: Retrospective study. Objectives: Adjacent segment infection after posterior lumbar fusion for noninfectious spinal surgery is rare. The incidence, etiology, and treatment of adjacent segment infections are rarely reported, and the objective of this study was to investigate the incidence, risk factors, diagnosis, and treatment of adjacent segment infection(ASI) in patients undergoing posterior lumbar fusion surgery for noninfectious spinal surgery. Methods: This retrospective study included patients who underwent lumbar decompression fusion surgery for the treatment of noninfectious lumbar spine diseases between 2008–2020. Clinical data collected from the First People’s Hospital of Yunnan Province included sex, age, comorbidities, visual analog scale (VAS) scores, Oswestry disability index (ODI) scores, and adjacent segment infections (ASIs). Results: A total of 6,325 patients undergoing posterior lumbar fusion surgery for noninfectious spinal surgery met the inclusion criteria. Seven patients (0.11%) developed ASIs. Five patients underwent posterior debridement, autologous iliac bone grafting, and prolonged internal fixation. Two patients were cured with combined anti-infectious therapy. Before the operation, the VAS score was 8.57 ± 0.98, the ODI score was 42.86 ± 3.85, the last follow-up VAS score was 2.0 ± 0.82, and the ODI score was 13.29 ± 2.92. At the last follow-up, all patients had an ASI segment that achieved bony fusion, and posterior lumbar fusion surgery for noninfectious lumbar spine diseases was associated with a 0.11% risk of ASI. Conclusions: Surgeons should be aware of the risk factors for site infection to be able to avoid its occurrence. Early diagnosis is based on the patient's symptoms, signs, laboratory tests, MRI examination.Timely application of sensitive antibiotics, intervertebral space debridement, autologous iliac bone graft fusion, and prolonged internal fixation are effective treatment measures.

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Section: Diagnosismentioning

confidence: 99%

Adjacent segment infection after posterior lumbar fusion surgery

Bao,

Han,

Chen

et al. 2023

Preprint

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Flap plus sub-flap irrigation and negative pressure therapy for infected extremity wounds

Kurlander

Swanson

Wee

et al. 2020

Orthoplastic Surgery

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A Reevaluation of the Risk of Infection Based on Time to Debridement in Open Fractures

Foote

Tornetta

Reito

et al. 2020

Journal of Bone and Joint Surgery

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Update This article was updated on February 9, 2021, because of a previous error. On page 269, in the Note at the end of the article, the surname that had read “Merner” now reads “Mener.” An erratum has been published: J Bone Joint Surg Am. 2021 Mar 17;103(6):e25. Background: Open fractures are one of the leading causes of disability worldwide. The threshold time to debridement that reduces the infection rate is unclear. Methods: We searched all available databases to identify observational studies and randomized trials related to open fracture care. We then conducted an extensive meta-analysis of the observational studies, using raw and adjusted estimates, to determine if there was an association between the timing of initial debridement and infection. Results: We identified 84 studies (18,239 patients) for the primary analysis. In unadjusted analyses comparing various “late” time thresholds for debridement versus “early” thresholds, there was an association between timing of debridement and surgical site infection (odds ratio [OR] = 1.29, 95% confidence interval [CI] = 1.11 to 1.49, p < 0.001, I2 = 30%, 84 studies, n = 18,239). For debridement performed between 12 and 24 hours versus earlier than 12 hours, the OR was higher in tibial fractures (OR = 1.37, 95% CI = 1.00 to 1.87, p = 0.05, I2 = 19%, 12 studies, n = 2,065), and even more so in Gustilo type-IIIB tibial fractures (OR = 1.46, 95% CI = 1.13 to 1.89, p = 0.004, I2 = 23%, 12 studies, n = 1,255). An analysis of Gustilo type-III fractures showed a progressive increase in the risk of infection with time. Critical time thresholds included 12 hours (OR = 1.51, 95% CI = 1.28 to 1.78, p < 0.001, I2 = 0%, 16 studies, n = 3,502) and 24 hours (OR = 2.17, 95% CI = 1.73 to 2.72, p < 0.001, I2 = 0%, 29 studies, n = 5,214). Conclusions: High-grade open fractures demonstrated an increased risk of infection with progressive delay to debridement. Level of Evidence: Prognostic Level IV. See Instruction for Authors for a complete description of the levels of evidence.

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Early Outcome of Culture-Negative Infection in Open Fractures of the Lower Limb: A Prospective Study

Cited by 4 publications

References 16 publications

Adjacent segment infection after posterior lumbar fusion surgery

Adjacent segment infection after posterior lumbar fusion surgery

Flap plus sub-flap irrigation and negative pressure therapy for infected extremity wounds

A Reevaluation of the Risk of Infection Based on Time to Debridement in Open Fractures

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