The incidence and consequences of early wound infection after internal fixation for trauma in HIV-positive patients

Abstract

We report a prospective single-blind controlled study of the incidence of early wound infection after internal fixation for trauma in 609 patients, of whom 132 were HIV-positive. Wounds were assessed for healing using the ASEPSIS score. There was no significant difference in the rate of infection between HIV-positive and HIV-negative patients undergoing clean surgery (4.2% vs 6%, respectively; p = 0.65). HIV-positive patients did not receive additional antibiotic prophylaxis or antiretroviral therapy as part of their management. The difference in the rate of infection between HIV-positive and HIV-negative patients with an open fracture or other contamination was not significant (33% vs 15%, respectively; p = 0.064). There was no relationship between CD4 count and infection rate. HIV status did not significantly influence the number of secondary surgical procedures (p = 0.183) or the likelihood of developing chronic osteomyelitis (p = 0.131). Although previous contamination from the time of injury was a risk factor for infection in mal- and nonunions, it was not significantly increased in HIV-positive patients (p = 0.144). We conclude that clean implant surgery in HIV-positive patients is safe, with no need for additional prophylaxis.

Late implant sepsis after fracture surgery in HIV positive patients

“…The early outcomes of this study have previously been published [12]. The current study is a prospective analysis of the long-term outcomes, looking specifically at the incidence of late implant sepsis in the HIV-positive cohort of patients.…”

“…A total of 609 patients (499 male and 110 female), undergoing a total of 638 procedures, were admitted to the earlier study [12]. It was ascertained whether they were on HAART preoperatively.…”

Trends in the Epidemiology of Osteomyelitis

“…Similarly, improved life expectancy among elderly patients with diabetes mellitus has resulted in more cases of neuropathy, vascular insufficiency, and the associated local complications of soft-tissue loss, bone destruction, and osteomyelitis 17,18 . To date, however, there are only a handful of epidemiological studies of osteomyelitis in the U.S., and these studies are limited to selected subsets of patients, as defined by age 19 , osteomyelitis type 20 , anatomical location 21 , or infecting organisms 22,23 . To our knowledge, there are no comprehensive epidemiological studies describing the entire spectrum of osteomyelitis in the U.S. With this background, our objective was to examine trends in the age and sex-specific incidence of osteomyelitis over a forty-one-year period from 1969 to 2009.…”

“…T 20,2015 and/or pelvis (19%). Consistent with temporal trends in the distribution of cases by underlying etiology, there was an increase in patients with osteomyelitis of the feet and/or toes and axial locations, but a decline in lower-extremity osteomyelitis of the long bones.…”

“…T 20,2015 *The values are given as the age and sex-adjusted incidence rates per 100,000 person-years; values in parentheses are the 95% CI.…”