Variations in the Organisms Causing Deep Surgical Site Infections in Fracture Patients at a Level I Trauma Center (2006–2015)

Abstract

Objectives: To quantify the current bacteriology of deep surgical site infections (SSIs) after fracture surgery at 1 institution and to compare those data with historical controls at the same institution, assessing variations in infecting organisms over the past decade. Design: Retrospective review. Setting: Level I trauma center. Patients/Participants: Two hundred forty-three patients requiring surgical intervention for deep SSI between January 2011 and December 2015 were compared with 211 patients requiring surgical intervention for deep SSI between December 2006 and December 2010. Intervention: None. Main Outcome Measurements: Bacteria were categorized as Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus, Enterococcus, gram-negative rods (GNR), gram-positive rods, anaerobes, or negative cultures. The proportion of each bacterial type was determined and compared with previously published data from the same trauma center (December 2006 to December 2010). Results: Patients most commonly had S. aureus infections (48%), followed by GNR (40%) and CoNS (19%). The proportion of CoNS species (26% vs. 12%, P < 0.01) in infected patients was significantly higher during the current study period compared with historical controls. The proportion of S. aureus species in infected patients was significantly less during the current study period (39% vs. 56%, P < 0.01). The reduction in the proportion of S. aureus species in infected patients was driven by a decrease in the proportion of methicillin-resistant S. aureus (MRSA) in the overall sample. Conclusions: Bacteriology of deep SSI of fractures has changed substantially over the past decade at our center, specifically the proportions of GNR, CoNS, and MRSA. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Effect of Supplemental Perioperative Oxygen on SSI Among Adults with Lower-Extremity Fractures at Increased Risk for Infection

“…Many of the previous clinical trials evaluated SSIs within 30 days of surgery or less 5,[9][10][11] . Many fracture-related infections (52% of deep SSIs in this study) are identified more than 90 days after definitive fixation, and the shorter follow-up periods used in prior studies could miss important treatment benefits for patients undergoing fracture surgery 26,27 . Finally, the reporting of treatment adherence was variable or nonexistent in many of the prior studies.…”

Association of Postoperative Infections After Fractures With Long-term Income Among Adults

“…We modified the CDC’s 90-day window to include infections that occurred up to 12 months after surgery. This modification was based on evidence, commonly applied in fracture research, that nearly half of fracture-related infections occur more than 90 days from the index procedure . We also included infections that occurred at the site of amputation.…”

“…This modification was based on evidence, commonly applied in fracture research, that nearly half of fracture-related infections occur more than 90 days from the index procedure. [22][23][24] We also included infections that occurred at the site of amputation. All suspected infections were identified using the CPT codes,…”

Effect of Intrawound Vancomycin Powder in Operatively Treated High-risk Tibia Fractures

“…[11][12][13][14] Vancomycin was chosen for its activity against gram-positive pathogens, the most common bacteria encountered in deep surgical site infections after fracture surgery. 15 A placebo powder was not used for the control group because of concern that a powder with no potential to reduce infection might be harmful. Patients in both study groups received all other infection prevention measures based on the standard of care at each participating hospital, including prophylactic perioperative antibiotics administered intravenously.…”