The incidence and microbiological profile of surgical site infections following internal fixation of closed and open fractures

Oliveira, Priscila Rosalba; Carvalho, Vladimir Cordeiro; Felix, Cassia da Silva; Paula, Adriana Pereira de; Santos-Silva, Jorge; Lima, Ana Lucia Lei Munhoz

doi:10.1016/j.rboe.2015.09.012

ABSTRACT

OBJECTIVE:

To evaluate the incidence and microbiological profile of surgical site infections (SSIs) associated with internal fixation of fractures and to compare differences in the SSIs observed among patients with closed and open fractures.

METHODS:

Retrospective study. Analyzed data included information from all patients who underwent surgery for fixation of closed or open fractures from January 2005 to December 2012 and remained outpatients for at least one year following surgery. Incidence of surgical site infection (SSI) was compared between patients with closed and open infection, as well as polymicrobial infection and infection related to Gram-negative bacilli (GNB). Cumulative antibiograms were performed to describe microbiological profiles.

RESULTS:

Overall incidence of SSI was 6%. This incidence was significantly higher among patients with open fractures (14.7%) than among patients with closed fractures (4.2%). The proportions of patients with polymicrobial infections and infections due to GNB were also significantly higher among patients with open fractures. Staphylococcus aureus and coagulase-negative Staphylococcus (CoNS) species were the primary infectious agents isolated from both groups. The overall incidence of MRSA (methicillin-resistant S. aureus) was 72%. A. baumannii was the predominant GNB isolate recovered from patients with open fractures and P. aeruginosa was the most frequent isolate recovered from patients with closed fractures, both exhibited low rates of susceptibility to carbapenems.

CONCLUSIONS:

Incidence of SSIs related to the internal fixation of fractures was significantly higher among patients with open fractures, indicating that an open fracture can be a risk factor for infection. Among the bacterial isolates, S. aureus (with a high prevalence of MRSA) and CoNS species were most prevalent. A. baumannii and P. aeruginosa isolates underscored the low rate of susceptibility to carbapenems that was observed in the present study.

Keywords:
Surgical wound infection; Internal fracture fixation; Open fractures; Closed fractures

[1] * Corresponding author. E-mail: priscila.rosalba@hc.fm.usp.br (P.R. Oliveira).

	Total	Closed fractures	Open fractures	Comparison between the groups with closed and open fractures
Patients	11,030	9143	1887	–
Patients with SSIs	664 (6%)	386 (4.2%)	278 (14.7%)	p<0.001
Patients with polymicrobial infections	199 (1.8%)	90 (1%)	109 (5.8%)	p<0.001
Patients with GNB infections	293 (2.65%)	130 (1.42%)	163 (8.64%)	p<0.001

Closed fractures	Open fractures
Total number of isolates
357	172

Primary agents
S. aureus (56 isolates – 33%)66% MRSA	S. aureus (83 isolates – 23%)75% MRSA
CoNS species (24 isolates – 14%)	CoNS species (51 isolates – 14%)Enterococcus spp. (51 isolates – 14%)76% sensitivity to vancomycin
P. aeruginosa (18 isolates – 10%)47% sensitivity to carbapenems	A. baumannii (44 isolates – 12%)57% sensitivity to imipenem

Brasil

Brasil

The incidence and microbiological profile of surgical site infections following internal fixation of closed and open fractures^{^☆} ☆ Work developed at the Universidade de São Paulo, Hospital das Clínicas, Instituto de Ortopedia e Traumatologia, São Paulo, SP, Brazil.

ABSTRACT

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

Brasil

Brasil

The incidence and microbiological profile of surgical site infections following internal fixation of closed and open fractures☆ ☆ Work developed at the Universidade de São Paulo, Hospital das Clínicas, Instituto de Ortopedia e Traumatologia, São Paulo, SP, Brazil.

ABSTRACT

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSIONS:

The incidence and microbiological profile of surgical site infections following internal fixation of closed and open fractures^{^☆} ☆ Work developed at the Universidade de São Paulo, Hospital das Clínicas, Instituto de Ortopedia e Traumatologia, São Paulo, SP, Brazil.