Microbiology and injury characteristics in severe open tibia fractures from combat

Burns, Travis C.; Stinner, Daniel J.; Mack, Andrew; Potter, Benjamin K.; Beer, Rob; Eckel, Tobin T.; Possley, Daniel R.; Beltran, Michael J.; Hayda, Roman A.; Andersen, Romney C.; Keeling, John J.; Frisch, H; Murray, Clinton K.; Wenke, Joseph C.; Ficke, James R.; Hsu, Joseph R.

doi:10.1097/ta.0b013e318241f534

Cited by 89 publications

(69 citation statements)

References 26 publications

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“…16 Majority of S.aureus was isolated from cases of orthopaedic SSI and procedure was open fractures with fixation followed by LSCS surgeries among who underwent emergency procedure. These findings were on par with findings of Burns TC et al 17 However, the incidence of MRSA was significantly higher in our study (37%) when compared with the findings of Burns TC et al, Kamat U et al 18 Various other studies have reported Pseudomonas aeruginosa and Escherichia coli as major isolates in their studies. However, the type of isolate is dependable upon variable physical and operational factors (Type of operation etc.).…”

Section: Discussioncontrasting

confidence: 56%

A prospective study of surgical site infections in a tertiary care hospital

2017

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INTRODUCTIONAmong the Health care associated infections (HAI), surgical site infections (SSI) previously termed as postoperative wound infections are one of the most common HAI in low and middle income countries. The prevalence of these infections varies widely ranging from 5-16%. In India, based upon the various studies prevalence of SSI varies between 5% and 24%.1 SSI are defined as an infection occurring within 30 days after a surgical operation (or within 1 year if an implant is left in place after procedure) and affecting either incision or deep tissues at the operation site.2 Despite advances in SSI control practices, like improved operating room ventilation, sterilization methods, use of barriers, surgical technique there has been an alarming rise in low and middle income countries. Increase in SSI is associated with increased morbidity, as well as mortality due to emergence of antimicrobial resistant pathogens. Factors related to development of SSI include patient related factors like smoking, diabetes etc. and also operation ABSTRACT Background: Among the Health care associated infections (HAI), surgical site infections (SSI) previously termed as post-operative wound infections are one of the most common HAI in low and middle income countries. Increase in SSI is associated with increased morbidity, as well as mortality due to emergence of antimicrobial resistant pathogens. Understanding the pathogens implicated in causing the SSIs and their antimicrobial sensitivity place a good role in reducing the mortality and morbidity. Methods: A prospective study was conducted at a tertiary care hospital to all the patients admitted in Department of surgery, Orthopedics and Gynecology and Obstetrics for six months from January 2016 to June 2016. The demographic data, inclusion criteria and exclusion criteria, risk factors, clinical history, laboratory data with gram stain, culture results and antibiotic sensitivity of the isolates were collected. Results: Two hundred patients were recruited in the study and the prevalence of SSI in the study was 3.83%. Patients who underwent emergency operations and diabetics were at higher risk of acquiring SSI. The most commonly isolated pathogens in the study were Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. Pseudomonas aeruginosa was most common isolate from orthopedic cases of SSI, Escherichia coli was most common isolate from intestinal surgeries and Staphylococcus aureus from LSCS. Increased rate of isolation of MRSA and ESBL strains were observed in the study. Conclusions: Study clearly explains the various causes and risk factors associated in development of SSI. The study guides in the type of the organism isolated and possible antibiotic of choice in treatment and management of SSI. The prevalence of SSI was 3.83%, which is comparable with some of the studies and lower than many of the studies.

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Section: Discussioncontrasting

confidence: 56%

A prospective study of surgical site infections in a tertiary care hospital

2017

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“…This finding is relevant given that MRSA is the predominant organism in 35% to 50% of clinically infected combat wounds [3,4]. Often, these wounds demand serial débridements to achieve healthy-appearing and/ Fig.…”

Section: Discussionmentioning

confidence: 99%

Bioburden Increases Heterotopic Ossification Formation in an Established Rat Model

Pavey

Qureshi

Hope

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Heterotopic ossification (HO) develops in a majority of combat-related amputations wherein early bacterial colonization has been considered a potential early risk factor. Our group has recently developed a small animal model of trauma-induced HO that incorporates many of the multifaceted injury patterns of combat trauma in the absence of bacterial contamination and subsequent wound colonization. Questions/purposes We sought to determine if (1) the presence of bioburden (Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus [MRSA]) increases the magnitude of ectopic bone formation in traumatized muscle after amputation; and (2) what persistent effects bacterial contamination has on late microbial flora within the amputation site. Methods Using a blast-related HO model, we exposed 48 rats to blast overpressure, femur fracture, crush injury, and subsequent immediate transfemoral amputation through the zone of injury. Control injured rats (n = 8) were inoculated beneath the myodesis with phosphate-buffered saline not containing bacteria (vehicle) and treatment rats were inoculated with 1 9 10 6 colony-forming units of A baumannii (n = 20) or MRSA (n = 20). All animals formed HO. Heterotopic ossification was determined by quantitative volumetric measurements of ectopic bone at 12-weeks postinjury using micro-CT and qualitative histomorphometry for assessment of new bone formation in the residual limb. Bone marrow and muscle tissue biopsies The authors are employees of the US Government. This work was prepared as part of their official duties. Title 17 USC §105 provides that ''Copyright protection under this title is not available for any work of the US Government.'' Title 17 USC §101 defined a US Government work as a work prepared by a military service member or employees of the US Government as part of that person's official duties. The opinions or assertions contained in this paper are the private views of the authors and are not to be construed as reflecting the views, policy or positions of the Departments of the Navy, Department of Defense nor the US Government. Each author certifies that his or her institution approved the animal protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. This work was performed at the Naval Medical Research Center, Silver Spring, MD, USA. were collected from the residual limb at 12 weeks to quantitatively measure the bioburden load and to qualitatively determine the species-level identification of the bacterial flora. Results At 12 weeks, we observed a greater volume of HO in rats infected with MRSA (68.9 ± 8.6 mm 3 ; 95% confidence interval [CI], 50.52-85.55) when compared with A baumannii (20.9 ± 3.7 mm 3

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“…This inability of surveillance cultures to accurately predict the infectious organism has been supported by other studies. [50][51][52][53] While surveillance cultures have limited value in predicting downstream infectious organisms, some studies have suggested a value in surveillance culture bacterial load quantification. This was recently addressed in a retrospective study conducted by Burns et al in a combat environment.…”

Section: Discussion Current Concepts In Open Fracture Care and Infectmentioning

confidence: 99%

“…Other studies have also demonstrated the value of quantifying bacterial loads of wounds for general infection prediction, either through the use of quantitative Gram staining or more commonly through the use of quantitative culturing. [53][54][55][56] The samples used for these bacteria quantifications were either wound swabs, wound effluent, or debrided tissue.…”

Section: Discussion Current Concepts In Open Fracture Care and Infectmentioning

confidence: 99%

Current Concepts and Ongoing Research in the Prevention and Treatment of Open Fracture Infections

Hannigan

Pulos

Grice

et al. 2015

Advances in Wound Care

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Significance: Open fractures are fractures in which the bone has violated the skin and soft tissue. Because of their severity, open fractures are associated with complications that can result in increased lengths of hospital stays, multiple operative interventions, and even amputation. One of the factors thought to influence the extent of these complications is exposure and contamination of the open fracture with environmental microorganisms, potentially those that are pathogenic in nature. Recent Advances: Current open fracture care aims to prevent infection by wound classification, prophylactic antibiotic administration, debridement and irrigation, and stable fracture fixation. Critical Issues: Despite these established treatment paradigms, infections and infection-related complications remain a significant clinical burden. To address this, improvements need to be made in our ability to detect bacterial infections, effectively remove wound contamination, eradicate infections, and treat and prevent biofilm formation associated with fracture fixation hardware. Future Directions: Current research is addressing these critical issues. While culture methods are of limited value, culture-independent molecular techniques are being developed to provide informative detection of bacterial contamination and infection. Other advanced contamination-and infection-detecting techniques are also being investigated. New hardware-coating methods are being developed to minimize the risk of biofilm formation in wounds, and immune stimulation techniques are being developed to prevent open fracture infections. SCOPE AND SIGNIFICANCEOpen fractures occur when bone is exposed through skin as a result of bone breaking through skin or wound penetration with fractured bone exposure. While multiple factors may influence open fracture rate, a recent study reported an incidence of 30.7/ 10 5

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Microbiology and injury characteristics in severe open tibia fractures from combat

Cited by 89 publications

References 26 publications

A prospective study of surgical site infections in a tertiary care hospital

A prospective study of surgical site infections in a tertiary care hospital

Bioburden Increases Heterotopic Ossification Formation in an Established Rat Model

Current Concepts and Ongoing Research in the Prevention and Treatment of Open Fracture Infections

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