Infectious Complications of Open Type III Tibial Fractures among Combat Casualties

Johnson, Erica; Burns, Travis C.; Hayda, Roman A.; Hospenthal, Duane R.; Murray, Clinton K.

doi:10.1086/520029

Cited by 244 publications

(150 citation statements)

References 20 publications

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“…On repeat culture, A. baumannii was not isolated in any patients after 6 to 8 weeks of broad spectrum antibiotics targeting MDR AB. In at least four of these patients, SA, but no A. baumannii was isolated when deep cultures were performed 2 to 15 months later [11]. A retrospective chart review concluded that initial episodes of combat-related osteomyelitis from the upper and lower extremities were more likely to be polymicrobial than monomicrobial.…”

Section: Discussionmentioning

confidence: 95%

Acinetobacter baumannii is not Associated with Osteomyelitis in a Rat Model: A Pilot Study

Collinet-Adler¹,

Castro²,

Ledonio³

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Multidrug resistant Acinetobacter baumannii (MDR AB) with and without Staphylococcus aureus (SA) is a commonly isolated organism in infected segmental bone defects in combat-related trauma in Iraq and Afghanistan. Although MDR AB in visceral infections is a therapeutic challenge, control of infection appears more common for combat-related osteomyelitis.Questions/purposes Using a rat model, we explored the virulence of MDR AB in segmental bone defects alone and in combination with SA. Methods Segmental defects in 60 rat femurs were created, stabilized, and inoculated with MDR AB alone and 60 with MDR AB and SA. We performed qualitative and quantitative bacteriology and radiographic assessments at 2, 4, and 8 weeks for MDR AB and at 1, 2, and 3 weeks for MDR AB and SA. Results Quantitative bacteriology revealed a 3-to 5-log decrease in MDR AB from the initial inoculum. After polymicrobial inoculation, only 10 of 60 animals had positive cultures for MDR AB, whereas 59 of 60 animals had positive cultures for SA. Recovered SA were 2 to 5 log greater than the initial inoculum, while there again was a 3-to 5-log decrease in MDR AB. MDR AB alone did not cause bony lysis, but there was radiographic evidence of new bone formation in 67% of the segmental defects. Osteolysis was noted with MDR AB and SA. Conclusions MDR AB did not appear to cause or contribute to clinically apparent osteomyelitis in this pilot study. Clinical Relevance Resolution of infections in combatrelated segmental bone defects inoculated with MDR AB may be attributable to low virulence.

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Section: Discussionmentioning

confidence: 95%

Acinetobacter baumannii is not Associated with Osteomyelitis in a Rat Model: A Pilot Study

Collinet-Adler¹,

Castro²,

Ledonio³

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…As survivorship has increased, even among patients with devastating extremity wounds that would have been fatal in the past, multidrug-resistant pathogens are complicating recovery [78]. A major concern is that past ill-advised use of broad-spectrum antibiotics for empirical treatment of combat wounds is resulting in selection of more resistant pathogens.…”

Section: Discussionmentioning

confidence: 99%

Treatment of War Wounds: A Historical Review

Manring

Hawk

Calhoun

et al. 2009

Clinical Orthopaedics &Amp; Related Research

142

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The treatment of war wounds is an ancient art, constantly refined to reflect improvements in weapons technology, transportation, antiseptic practices, and surgical techniques. Throughout most of the history of warfare, more soldiers died from disease than combat wounds, and misconceptions regarding the best timing and mode of treatment for injuries often resulted in more harm than good. Since the 19th century, mortality from war wounds steadily decreased as surgeons on all sides of conflicts developed systems for rapidly moving the wounded from the battlefield to frontline hospitals where surgical care is delivered. We review the most important trends in US and Western military trauma management over two centuries, including the shift from primary to delayed closure in wound management, refinement of amputation techniques, advances in evacuation philosophy and technology, the development of antiseptic practices, and the use of antibiotics. We also discuss how the lessons of history are reflected in contemporary US practices in Iraq and Afghanistan.

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“…1 Similarly, infection is the most common cause of delayed amputation in combat-related open tibial fractures. 2 Bacteria produce biofilm that is protective against microbial agents, 3 and the antibiotic concentrations needed to eliminate these sessile colonies found in biofilms can be more than 500 times those required to kill planktonic bacteria. 4 The high doses of systemic antibiotics that are above the minimum inhibitory concentration required at the fracture site may cause systemic toxicity.…”

mentioning

confidence: 99%

Effect of various concentrations of antibiotics on osteogenic cell viability and activity

Rathbone

Cross

Brown

et al. 2011

Journal Orthopaedic Research

289

224

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Infection is a common complication of open fractures. Systemic antibiotics often cause adverse events before eradication of infected bone occurs. The local delivery of antibiotics and the use of implants that deliver both growth factors and antimicrobials are ways to circumvent systemic toxicity while decreasing infection and to reach extremely high levels required to treat bacterial biofilms. When choosing an antibiotic for a local delivery system, one should consider the effect that the antibiotic has on cell viability and osteogenic activity. To address this concern, osteoblasts were treated with 21 different antibiotics over 8 concentrations from 0 to 5,000 mg/ml. Osteoblast deoxyribonucleic acid content and alkaline phosphatase activity (ALP) were measured to determine cell number and osteogenic activity, respectively. Antibiotics that caused the greatest decrement include rifampin, minocycline, doxycycline, nafcillin, penicillin, ciprofloxacin, colistin methanesulfonate, and gentamicin; their cell number and ALP were significantly less than control at drug concentrations 200 mg/ ml. Conversely, amikacin, tobramycin, and vancomycin were the least cytotoxic and did not appreciably affect cell number and ALP until very high concentrations were used. This comprehensive evaluation of numerous antibiotics' effects on osteoblast viability and activity will enable clinicians and researchers to choose the optimal antibiotic for treatment of infection and maintenance of healthy host bone. ß

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Infectious Complications of Open Type III Tibial Fractures among Combat Casualties

Cited by 244 publications

References 20 publications

Acinetobacter baumannii is not Associated with Osteomyelitis in a Rat Model: A Pilot Study

Acinetobacter baumannii is not Associated with Osteomyelitis in a Rat Model: A Pilot Study

Treatment of War Wounds: A Historical Review

Effect of various concentrations of antibiotics on osteogenic cell viability and activity

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