The Microbiology and Risk of Infection Following Open, Agricultural Upper Extremity Injuries

Ali, Mir H.; Hoekzema, Nathaniel A.; Bakleh, Mohanand; Shin, Alexander Y.; Osmon, Douglas R.

doi:10.1016/j.jhsa.2007.09.003

Cited by 13 publications

(7 citation statements)

References 17 publications

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“…In our study, isolates of Clostridium spp. were culture positive a week earlier than reported among civilian trauma patients with extremity injuries, but similar to timing seen in prior war wound studies (Ali et al, 2008; Ibnoulkhatib et al, 2012; Lindberg et al, 1955; Miles et al, 1940). Except for Clostridium spp., isolates were recovered later than previously documented, potentially suggestive of nosocomial transmission, environmental inoculation, or delay due to empiric antibiotics near the point of injury.…”

Section: 0 Discussionsupporting

confidence: 81%

“…Clindamycin (53%) and moxifloxacin (65%) were least active against B. fragilis in our study, which is similar to 66–86% reported in the literature (Karlowsky et al, 2012; Lee et al, 2010; Nagy et al, 2011; Snydman et al, 2010; Wybo et al, 2014). Our rate of resistance (73%) is similar to that of civilian agricultural wounds (65%), which is the closest injury pattern to war wounds (Ali et al, 2008). …”

Section: 0 Discussionsupporting

confidence: 63%

“…Almost half of obligate anaerobe isolates in this study were Bacteroides spp., which was a shift from previous findings, indicating that Clostridium species were the predominant obligate anaerobes among war trauma (WWI to the Korean War) and many agricultural injuries (Ali et al, 2008; Fleming et al, 1915; Lindberg et al, 1955; Miles et al, 1940). Due in part to the predominance of Clostridium spp., it has long been postulated that anaerobes complicating war wounds are from the environment, particularly the soil (Lindberg et al, 1955).…”

Section: 0 Discussioncontrasting

confidence: 54%

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Epidemiology and antimicrobial susceptibilities of wound isolates of obligate anaerobes from combat casualties

White

Mende

Weintrob

et al. 2016

Diagnostic Microbiology and Infectious Disease

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Data from recent conflicts related to war wounds and obligate anaerobes are limited. We define the epidemiology and antimicrobial susceptibility of obligate anaerobes from Iraq and Afghanistan casualties (6/2009–12/2013), as well as their association with clinical outcomes. Susceptibility against eleven antibiotics (7 classes) was tested. Overall, 59 patients had 119 obligate anaerobes identified (83 were first isolates). Obligate anaerobes were isolated 7–13 days post-injury, primarily from lower extremity wounds (43%), and were largely Bacteroides spp. (42%) and Clostridium spp. (19%). Patients with pelvic wounds were more likely to have Bacteroides spp. and concomitant resistant gram-negative aerobes. Seventy-three percent of isolates were resistant to ≥1 antimicrobials. Bacteroides spp. demonstrated the most resistance (16% of first isolates). Patients with resistant isolates had similar outcomes to those with susceptible strains. Serial recovery of isolates occurred in 15% of patients and was significantly associated with isolation of Bacteroides spp., along with resistant gram-negative aerobes.

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Section: 0 Discussionsupporting

confidence: 81%

Section: 0 Discussionsupporting

confidence: 63%

Section: 0 Discussioncontrasting

confidence: 54%

See 1 more Smart Citation

Epidemiology and antimicrobial susceptibilities of wound isolates of obligate anaerobes from combat casualties

White

Mende

Weintrob

et al. 2016

Diagnostic Microbiology and Infectious Disease

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“…Interestingly, agricultural employment was found to be a potent risk for polymicrobial PTO, showing a 2.86-fold higher risk and reaching statistical significance in the multivariable-adjusted analysis. Ali et al, have previously shown a strong association between open, agricultural upper extremities injuries and PTO (18.7%), with 37.5% having polymicrobial infection 17 . Gustilo III fractures of the lower limb are life-threatening injuries, in which inoculation of microorganisms into the bone commonly happen soon after trauma from soft tissue contamination or during surgery 7 - 9 .…”

Section: Discussionmentioning

confidence: 95%

Outcomes and Risk Factors for Polymicrobial Posttraumatic Osteomyelitis

Jorge

Fucuta

et al. 2018

J. Bone Joint Infect.

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Background: We hypothesized that polymicrobial posttraumatic osteomyelitis (PTO) may be associated with worse outcomes when compared to monomicrobial PTO. We therefore attempted to show the outcomes and predisposing factors associated with polymicrobial PTO.Methods: A single-center case-control study was carried out from 2007 to 2012. The outcome variables analyzed were: the need for additional surgical and antibiotic treatments, rates of amputation, and mortality associated with the infection. Univariate and multivariable analyses using multiple logistic regression were performed to identify risk factors associated with polymicrobial PTO, and p < 0.05 was considered significant.Results: Among the 193 patients identified, polymicrobial PTO was diagnosed in 37.8%, and was significantly associated with supplementary surgical debridement (56.1% vs. 31%; p < 0.01), a higher consumption of antibiotics, and more amputations (6.5% vs 1.3%; p < 0.01). Factors associated with polymicrobial PTO in the multivariable analysis were older age (odds ratio [OR] = 1.02, 95% confidence interval [CI] = 1.01 to 1.03, p = 0.04), working in agriculture (OR = 2.86, 95% CI = 1.05 to 7.79, p = 0.04), open fracture Gustilo type III (OR = 2.38, 95% CI = 1.02 to 5.56, p = 0.04), need for blood transfusion (OR = 2.15, 95% CI = 1.07 to 4.32, p = 0.03), and need for supplementary debridement (OR = 2.58, 95% CI = 1.29 to 5.16, p = 0.01).Conclusions: PTO is polymicrobial in more than one-third of patients, associated with extra surgical and clinical treatment, and worse outcomes including higher rates of amputation.

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“…24 Agricultural injuries are often contaminated by staphylococci, enterococci and aerobic gram-negative bacilli, 25 whereas multidrug-resistant acinetobacter has been found in military injuries. Coverage against gram-negative bacteria and Clostridium spp.…”

Section: Antibiotic Prophylaxismentioning

confidence: 99%