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Herold J, Notov D, Reeps C, Schaser KD, Kamin K, Mäder M, Kleber C. Limb salvage in traumatic hemipelvectomy: case series with surgical management and review of the literature. Arch Orthop Trauma Surg 2023; 143:6177-6192. [PMID: 37314526 PMCID: PMC10491572 DOI: 10.1007/s00402-023-04913-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/19/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Traumatic hemipelvectomies are rare and serious injuries. The surgical management was described in several case studies, with primary amputation often performed to save the patient's life. METHODS We report of two survivors with complete traumatic hemipelvectomy resulting in ischemia and paralyzed lower extremity. Due to modern emergency medicine and reconstructive surgery, limb salvage could be attained. Long-term outcome with quality of life was assessed one year after the initial accident. RESULTS AND CONCLUSIONS The patients were able to mobilize themselves and live an independent life. The extremities remained without function and sensation. Urinary continence and sexual function were present and the colostomy could be relocated in both patients. Both patients support limb salvage, even having difficulties and follow-up treatments. Concomitant cases are required to consolidate the findings. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- J Herold
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany.
| | - D Notov
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - C Reeps
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - K D Schaser
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - K Kamin
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - M Mäder
- University Center of Orthopaedic, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - C Kleber
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
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Wong FK, Fruge S, Meulendijks MZ, Christensen JM, Iskhakov D, Ahn L, Valerio IL, Eberlin KR. Secondary amputation after lower extremity free-flap reconstruction. J Plast Reconstr Aesthet Surg 2023; 83:276-281. [PMID: 37290368 DOI: 10.1016/j.bjps.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/02/2023] [Accepted: 04/08/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Microsurgical free-tissue transfer is often the definitive reconstructive option for lower extremity limb salvage. Despite an initial successful free-flap reconstruction, some patients ultimately undergo lower extremity amputation. The indications for secondary amputation include non- or malunion, infection, hardware failure, or chronic pain. This study aimed to identify the etiology and outcome of secondary amputation after lower extremity free-flap reconstruction. METHODS A retrospective cohort study was performed including patients who underwent lower extremity free-flap reconstruction from January 2002 to December 2020. Patients who underwent secondary amputation were identified. A survey based on the PROMIS® Pain Interference Scale and activities of daily living (ADLs) was then conducted to assess patient-reported outcomes. Fifteen (52%) patients who underwent amputation responded to the survey, with a median follow-up time of 4.4 years. RESULTS Of 410 patients who underwent lower extremity free-flap reconstruction, 40 (9.8%) patients underwent subsequent amputation. Of these, 10 patients had failed free-flap reconstruction and 30 patients had secondary amputation after an initially successful soft tissue coverage. The most common etiology for secondary amputation was infection (68%, n = 27). Eighty percent (n = 12) of survey respondents were able to use a prosthetic limb and ambulate. CONCLUSIONS The most common etiology of secondary amputation was infection. Most patients who ultimately underwent amputation were able to ambulate with a prosthetic, but the majority of patients reported chronic pain. This study could be used to guide potential free-flap candidates regarding the risks and outcomes of lower extremity free-flap reconstruction.
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Affiliation(s)
- F K Wong
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - S Fruge
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - M Z Meulendijks
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - J M Christensen
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America; Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - D Iskhakov
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - L Ahn
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - I L Valerio
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - K R Eberlin
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
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Mitra S, Mallick A, Priyadarshini S. Effect of polymicrobial interactions on antimicrobial resistance: an in vitro analysis in human ocular infections. Future Microbiol 2022; 17:491-504. [PMID: 35315292 DOI: 10.2217/fmb-2021-0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose: Investigate the effect of polymicrobial interactions on antimicrobial resistance (AMR) of ocular pathogens in polymicrobial settings, compared with monomicrobial infections. Methods: Polymicrobial interactions were labeled as antagonistic, synergistic or indifferent based on a reduction, an increase or no change, respectively, in antibiotics' MIC by the Vitek 2 compact system, compared with monomicrobial pathogens. Results: Staphylococcus epidermidis showed antagonistic polymicrobial interactions (22.6%); Pseudomonas aeruginosa showed synergistic interactions (62.5%); multidrug-resistant Acinetobacter baumannii showed increased susceptibility to select antibiotics; Serratia ficaria (inherently colistin resistant) became colistin-susceptible in polymicrobial combinations. Conclusion: Both antagonistic and synergistic interactions exist among human pathogens in polymicrobial settings. Gram-positive pathogens had significantly higher antagonistic polymicrobial interactions (increased MICs: 20.4%) compared with Gram-negative ones (synergistic: 59.4%).
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Affiliation(s)
- Sanchita Mitra
- Jhaveri Microbiology Centre, LV Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, 500034, India
| | - Aparajita Mallick
- Ocular Microbiology Services, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, 751024, India
| | - Shilpa Priyadarshini
- Ocular Microbiology Services, LV Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, 751024, India
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Asker D, Awad TS, Raju D, Sanchez H, Lacdao I, Gilbert S, Sivarajah P, Andes DR, Sheppard DC, Howell PL, Hatton BD. Preventing Pseudomonas aeruginosa Biofilms on Indwelling Catheters by Surface-Bound Enzymes. ACS APPLIED BIO MATERIALS 2021; 4:8248-8258. [PMID: 35005941 DOI: 10.1021/acsabm.1c00794] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Implanted medical devices such as central venous catheters are highly susceptible to microbial colonization and biofilm formation and are a major risk factor for nosocomial infections. The opportunistic pathogen Pseudomonas aeruginosa uses exopolysaccharides, such as Psl, for both initial surface attachment and biofilm formation. We have previously shown that chemically immobilizing the Psl-specific glycoside hydrolase, PslGh, to a material surface can inhibit P. aeruginosa biofilm formation. Herein, we show that PslGh can be uniformly immobilized on the lumen surface of medical-grade, commercial polyethylene, polyurethane, and polydimethylsiloxane (silicone) catheter tubing. We confirmed that the surface-bound PslGh was uniformly distributed along the catheter length and remained active even after storage for 30 days at 4 °C. P. aeruginosa colonization and biofilm formation under dynamic flow culture conditions in vitro showed a 3-log reduction in the number of bacteria during the first 11 days, and a 2-log reduction by day 14 for PslGh-modified PE-100 catheters, compared to untreated catheter controls. In an in vivo rat infection model, PslGh-modified PE-100 catheters showed a ∼1.5-log reduction in the colonization of the clinical P. aeruginosa ATCC 27853 strain after 24 h. These results demonstrate the robust ability of surface-bound glycoside hydrolase enzymes to inhibit biofilm formation and their potential to reduce rates of device-associated infections.
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Affiliation(s)
- Dalal Asker
- Department of Materials Science & Engineering, University of Toronto, Toronto M5S 3E4, Canada.,Food Science & Technology Department, Alexandria University, Alexandria 21526, Egypt
| | - Tarek S Awad
- Department of Materials Science & Engineering, University of Toronto, Toronto M5S 3E4, Canada
| | - Deepa Raju
- Program in Molecular Medicine, The Hospital for Sick Children, Toronto M5G 1X8, Canada
| | - Hiram Sanchez
- Department of Medicine, University of Wisconsin, 600 Highland Avenue, Madison 53706, Wisconsin, United States
| | - Ira Lacdao
- Program in Molecular Medicine, The Hospital for Sick Children, Toronto M5G 1X8, Canada
| | - Stephanie Gilbert
- Program in Molecular Medicine, The Hospital for Sick Children, Toronto M5G 1X8, Canada
| | - Piyanka Sivarajah
- Program in Molecular Medicine, The Hospital for Sick Children, Toronto M5G 1X8, Canada
| | - David R Andes
- Department of Medicine, University of Wisconsin, 600 Highland Avenue, Madison 53706, Wisconsin, United States.,Medical Microbiology and Immunology, University of Wisconsin, Madison 53706, Wisconsin, United States
| | - Donald C Sheppard
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal H4A 3J1, Canada.,Department of Microbiology and Immunology, McGill University, Montreal H3A 0G4, Canada.,Department of Medicine, McGill University, Montreal H3A 0G4, Canada.,McGill Interdisciplinary Initiative in Infection and Immunity (MI4), Montreal H3A 0G4, Canada
| | - P Lynne Howell
- Program in Molecular Medicine, The Hospital for Sick Children, Toronto M5G 1X8, Canada.,Department of Biochemistry, University of Toronto, Toronto M5S 3E4, Canada
| | - Benjamin D Hatton
- Department of Materials Science & Engineering, University of Toronto, Toronto M5S 3E4, Canada
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Hand TL, Hand EO, Welborn A, Zelle BA. Gram-Negative Antibiotic Coverage in Gustilo-Anderson Type-III Open Fractures. J Bone Joint Surg Am 2020; 102:1468-1474. [PMID: 32310842 DOI: 10.2106/jbjs.19.01358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Thomas L Hand
- Department of Orthopaedics (T.L.H. and B.A.Z.) and the Pharmacotherapy Education and Research Center (E.O.H. and A.W.), UT Health San Antonio, San Antonio, Texas
| | - Elizabeth O Hand
- Department of Orthopaedics (T.L.H. and B.A.Z.) and the Pharmacotherapy Education and Research Center (E.O.H. and A.W.), UT Health San Antonio, San Antonio, Texas.,Department of Pharmacotherapy and Pharmacy Services, University Health System, San Antonio, Texas
| | - Amber Welborn
- Department of Orthopaedics (T.L.H. and B.A.Z.) and the Pharmacotherapy Education and Research Center (E.O.H. and A.W.), UT Health San Antonio, San Antonio, Texas
| | - Boris A Zelle
- Department of Orthopaedics (T.L.H. and B.A.Z.) and the Pharmacotherapy Education and Research Center (E.O.H. and A.W.), UT Health San Antonio, San Antonio, Texas
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Non-eluting, surface-bound enzymes disrupt surface attachment of bacteria by continuous biofilm polysaccharide degradation. Biomaterials 2018; 167:168-176. [DOI: 10.1016/j.biomaterials.2018.03.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/28/2018] [Accepted: 03/12/2018] [Indexed: 11/19/2022]
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Renz N, Cabric S, Morgenstern C, Schuetz MA, Trampuz A. Value of PCR in sonication fluid for the diagnosis of orthopedic hardware-associated infections: Has the molecular era arrived? Injury 2018; 49:806-811. [PMID: 29486892 DOI: 10.1016/j.injury.2018.02.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 02/17/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Bone healing disturbance following fracture fixation represents a continuing challenge. We evaluated a novel fully automated polymerase chain reaction (PCR) assay using sonication fluid from retrieved orthopedic hardware to diagnose infection. PATIENTS AND METHODS In this prospective diagnostic cohort study, explanted orthopedic hardware materials from consecutive patients were investigated by sonication and the resulting sonication fluid was analyzed by culture (standard procedure) and multiplex PCR (investigational procedure). Hardware-associated infection was defined as visible purulence, presence of a sinus tract, implant on view, inflammation in peri-implant tissue or positive culture. McNemar's chi-squared test was used to compare the performance of diagnostic tests. For the clinical performance all pathogens were considered, whereas for analytical performance only microorganisms were considered for which primers are included in the PCR assay. RESULTS Among 51 patients, hardware-associated infection was diagnosed in 38 cases (75%) and non-infectious causes in 13 patients (25%). The sensitivity for diagnosing infection was 66% for peri-implant tissue culture, 84% for sonication fluid culture, 71% (clinical performance) and 77% (analytical performance) for sonication fluid PCR, the specificity of all tests was >90%. The analytical sensitivity of PCR was higher for gram-negative bacilli (100%), coagulase-negative staphylococci (89%) and Staphylococcus aureus (75%) than for Cutibacterium (formerly Propionibacterium) acnes (57%), enterococci (50%) and Candida spp. (25%). CONCLUSION The performance of sonication fluid PCR for diagnosis of orthopedic hardware-associated infection was comparable to culture tests. The additional advantage of PCR was short processing time (<5 h) and fully automated procedure. With further improvement of the performance, PCR has the potential to complement conventional cultures.
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Affiliation(s)
- Nora Renz
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany.
| | - Sabrina Cabric
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Berlin, Germany
| | - Christian Morgenstern
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany
| | - Michael A Schuetz
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany
| | - Andrej Trampuz
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Berlin, Germany
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Abstract
BACKGROUND Infections after osteosynthesis are a feared complication of the surgical treatment of fractures and should be dealt with by a multidisciplinary team. In addition to the surgeon, also included in this multidisciplinary team are a specialist for infectious diseases, a microbiologist, a radiologist and often a plastic surgeon. This review article describes the current knowledge on the pathogenesis, diagnostics, classification and treatment. The aim is to demonstrate some basic rules in the treatment of infections associated with implants and to show potential therpeutic approaches. MATERIAL AND METHODS The principles of diagnostics and combined surgical and antibiotic treatment are presented based on the current specialist literature. RESULTS With the help of a team approach the goals of treatment of an infected osteosynthesis, i.e. fracture healing, return to function and eradication of infection can be achieved. While the osteosynthesis material can usually be retained in acute infections, it is better to remove the infected hardware in chronic infections as eradication of the mature biofilm is no longer possible. DISCUSSION With adequate local wound débridement, the use of local and systemic antibiotics, as indicated by the specialist for infectious diseases and appropriate soft tissue coverage and wound closure, acute as well as chronic infections can be successfully treated. Nowadays, the surgeon has many different options for the management of bone defects. Depending on the anatomical location and the size of the defect a variety of techniques ranging from acute shortening to the Masquelet technique up to the Ilizarov distraction technique are available. These techniques should be combined with local bactericidal treatment.
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Affiliation(s)
- O Borens
- Abteilung für Traumatologie und Abteilung für Septische Chirurgie, Klinik für Orthopaedie und Traumtologie, Universitätsspital Lausanne - CHUV, Universität Lausanne, Rue du Bugnon 46, 1011, Lausanne, Schweiz.
| | - N Helmy
- Abteilung für Orthopaedie und Traumtologie des Bewegungsapparates, Bürgerspital Solothurn, Solothurn, Schweiz
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10
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Optimizing intravenous fosfomycin dosing in combination with carbapenems for treatment of Pseudomonas aeruginosa infections in critically ill patients based on pharmacokinetic/pharmacodynamic (PK/PD) simulation. Int J Infect Dis 2016; 50:23-9. [DOI: 10.1016/j.ijid.2016.06.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/11/2016] [Accepted: 06/15/2016] [Indexed: 01/14/2023] Open
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Degli Agosti I, Ginelli E, Mazzacane B, Peroni G, Bianco S, Guerriero F, Ricevuti G, Perna S, Rondanelli M. Effectiveness of a Short-Term Treatment of Oxygen-Ozone Therapy into Healing in a Posttraumatic Wound. Case Rep Med 2016; 2016:9528572. [PMID: 27738434 PMCID: PMC5055932 DOI: 10.1155/2016/9528572] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 06/27/2016] [Indexed: 12/15/2022] Open
Abstract
Introduction. A number of studies suggest that oxygen-ozone therapy may have a role in the treatment of chronic, nonhealing, or ischemic wounds for its disinfectant and antibacterial properties. Nonhealing wounds are a significant cause of morbidity. Here we present a case of subcutaneous oxygen-ozone therapy used to treat a nonhealing postoperative wound in a young man during a period of 5 weeks. Case Presentation. A 46-year-old man had a motorcycle accident and underwent amputation of the right tibia and fibula. At the discharge he came to our attention to start rehabilitation treatment. At that time the wound was ulcerated but it was afebrile with no signs of inflammation and negativity to blood tests. At 2 months from the trauma despite appropriate treatment and dressing, the wound was slowly improving and the patient complained of pain. For this reason in addition to standard dressing he underwent oxygen-ozone therapy. After 5 weeks of treatment the wound had healed. Conclusion. In patients with nonhealing wounds, oxygen-ozone therapy could be helpful in speeding the healing and reducing the pain thanks to its disinfectant property and by the increase of endogenous oxygen free radicals' scavenging properties. Compared to standard dressing and other treatments reported in the literature it showed a shorter time of action.
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Affiliation(s)
- Irene Degli Agosti
- Rehabilitation Unit, Azienda di Servizi alla Persona di Pavia, 27100 Pavia, Italy
| | - Elena Ginelli
- Rehabilitation Unit, Azienda di Servizi alla Persona di Pavia, 27100 Pavia, Italy
| | - Bruno Mazzacane
- Rehabilitation Unit, Azienda di Servizi alla Persona di Pavia, 27100 Pavia, Italy
| | - Gabriella Peroni
- Department of Public Health, Experimental and Forensic Medicine, School of Medicine, Endocrinology and Nutrition Unit, University of Pavia, Pavia, Italy
| | - Sandra Bianco
- Section of Geriatrics, Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy
| | - Fabio Guerriero
- Section of Geriatrics, Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy
| | - Giovanni Ricevuti
- Section of Geriatrics, Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy
| | - Simone Perna
- Department of Public Health, Experimental and Forensic Medicine, School of Medicine, Endocrinology and Nutrition Unit, University of Pavia, Pavia, Italy
| | - Mariangela Rondanelli
- Department of Public Health, Experimental and Forensic Medicine, School of Medicine, Endocrinology and Nutrition Unit, University of Pavia, Pavia, Italy
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Oliveira PR, Carvalho VC, da Silva Felix C, de Paula AP, Santos‐Silva J, Munhoz Lima ALL. Infecção de sítio cirúrgico após fixação de fraturas fechadas e expostas – Incidência e perfil microbiológico. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2015.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Oliveira PR, Carvalho VC, da Silva Felix C, de Paula AP, Santos-Silva J, Lima ALLM. The incidence and microbiological profile of surgical site infections following internal fixation of closed and open fractures. Rev Bras Ortop 2016; 51:396-9. [PMID: 27517016 PMCID: PMC4974164 DOI: 10.1016/j.rboe.2015.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 09/09/2015] [Indexed: 11/12/2022] Open
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.
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Affiliation(s)
- Priscila Rosalba Oliveira
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Vladimir Cordeiro Carvalho
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Cassia da Silva Felix
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Adriana Pereira de Paula
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Jorge Santos-Silva
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Ana Lucia Lei Munhoz Lima
- Universidade de São Paulo, Hospital das Clínicas, Instituto de Ortopedia e Traumatologia, São Paulo, SP, Brazil
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Ahmadi K, Hashemian AM, Bolvardi E, Hosseini PK. Vancomycin-Resistant Pseudomonas Aeroginosa in the Cases of Trauma. Med Arch 2016; 70:57-60. [PMID: 26980934 PMCID: PMC4779343 DOI: 10.5455/medarh.2016.70.57-60] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 01/05/2016] [Indexed: 11/25/2022] Open
Abstract
Background: One of the main problems in the treatment of cases of P. aeruginosa especially in the orthopedic infections is the occurrence of high antibiotic resistance. The present study was carried out in order to investigate the prevalence of vancomycin-resistant P. aeruginosa in the cases of trauma in Iran. Methods: Two hundred and fifty swab samples were collected from the site of trauma from the patients who referred to the orthopedic wards of the Iranian health centers. Samples were cultured immediately and those that were P. aeruginosa-positive were analyzed by the disk diffusion method. Results: Of 250 swab samples collected, 43 were positive for P. aeruginosa (17.2%). The results of the culture technique were also confirmed by the PCR reaction. Of 43 P. aeruginosa isolates, 32 strains (74.41%) were resistant to vancomycin. Total prevalence of bacteria in Tehran and Mashhad hospitals were 18.46% and 15.83%, respectively. Statistically significant difference was seen for the prevalence of vancomycin-resistant P. aeruginosa between the samples collected from Tehran and Mashhad (P =0.027). More than 55 years old and less than 10 years old patients had the highest prevalence of P. aeruginosa. P. aeruginosa strains of male and more than 55 years old patients harbored the highest levels of resistance against vancomycin. Conclusions: It is logical to primary identification of type of bacteria causing infection in the site of trauma and then using from the disk diffusion method to choose the best antimicrobial agent. Highest levels of health care should be performed for the patients less than 10 years and more than 55 years old patients.
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Affiliation(s)
- Koorosh Ahmadi
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Amir Masoud Hashemian
- Department of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Bolvardi
- Department of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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