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Surgical Site Infection Following Intramedullary Nailing of Subtrochanteric Femoral Fractures

Aim: To investigate the incidence, risk factors and pathogenic micro-organisms causing superficial and deep infection in subtrochanteric femoral fractures managed with an intramedullary nail. Materials and Methods: Following institutional board approval, all consecutive patients presenting with a su...

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Autores principales: Panteli, Michalis, Vun, James S. H., West, Robert M., Howard, Anthony, Pountos, Ippokratis, Giannoudis, Peter V.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8347680/
https://www.ncbi.nlm.nih.gov/pubmed/34362123
http://dx.doi.org/10.3390/jcm10153331
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author Panteli, Michalis
Vun, James S. H.
West, Robert M.
Howard, Anthony
Pountos, Ippokratis
Giannoudis, Peter V.
author_facet Panteli, Michalis
Vun, James S. H.
West, Robert M.
Howard, Anthony
Pountos, Ippokratis
Giannoudis, Peter V.
author_sort Panteli, Michalis
collection PubMed
description Aim: To investigate the incidence, risk factors and pathogenic micro-organisms causing superficial and deep infection in subtrochanteric femoral fractures managed with an intramedullary nail. Materials and Methods: Following institutional board approval, all consecutive patients presenting with a subtrochanteric fracture were retrospectively identified, over an 8-year period. Basic demographics, fracture characteristics, fracture union, revision operation, mortality and other complications were reported and analysed. Variables deemed statistically significant (p-value < 0.05) were then included into a revised adjusted model of logistic regression analysis, where we reported on the odds ratio (OR). Results: The overall incidence of infection was 6.4% (n = 36/561; superficial: 3.7%; deep: 2.7%). Associations with deep infection included: non-union (OR 9.29 (2.56–3.38)), the presence of an open fracture (OR 4.23 (3.18–5.61)), the need for massive transfusion (OR 1.42 (2.39–8.39)), post-operative transfusion (OR 1.40 (1.10–1.79)) and prolonged length of stay (OR 1.04 (1.02–1.06)). The Commonest causes of superficial infection were Staphylococcus aureus (28.5%), enteric flora (23.8%) and mixed flora (23.8%); whereas coliforms (60%) and Staphylococcus aureus (26.7%) were the commonest micro-organisms isolated in deep infection. Polymicrobial infection was identified in 38.5% and 80% of superficial and deep infections, respectively. Conclusion: Causative micro-organisms identified in both superficial and deep infection were similar to those reported in post-traumatic osteomyelitis. In an attempt to minimise infection, the treating clinician should focus on modifiable risk factors with adequate patient optimisation, prompt surgical treatment, adequate antibiotic coverage and wound care when treating patients with subtrochanteric femur fracture.
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spelling pubmed-83476802021-08-08 Surgical Site Infection Following Intramedullary Nailing of Subtrochanteric Femoral Fractures Panteli, Michalis Vun, James S. H. West, Robert M. Howard, Anthony Pountos, Ippokratis Giannoudis, Peter V. J Clin Med Article Aim: To investigate the incidence, risk factors and pathogenic micro-organisms causing superficial and deep infection in subtrochanteric femoral fractures managed with an intramedullary nail. Materials and Methods: Following institutional board approval, all consecutive patients presenting with a subtrochanteric fracture were retrospectively identified, over an 8-year period. Basic demographics, fracture characteristics, fracture union, revision operation, mortality and other complications were reported and analysed. Variables deemed statistically significant (p-value < 0.05) were then included into a revised adjusted model of logistic regression analysis, where we reported on the odds ratio (OR). Results: The overall incidence of infection was 6.4% (n = 36/561; superficial: 3.7%; deep: 2.7%). Associations with deep infection included: non-union (OR 9.29 (2.56–3.38)), the presence of an open fracture (OR 4.23 (3.18–5.61)), the need for massive transfusion (OR 1.42 (2.39–8.39)), post-operative transfusion (OR 1.40 (1.10–1.79)) and prolonged length of stay (OR 1.04 (1.02–1.06)). The Commonest causes of superficial infection were Staphylococcus aureus (28.5%), enteric flora (23.8%) and mixed flora (23.8%); whereas coliforms (60%) and Staphylococcus aureus (26.7%) were the commonest micro-organisms isolated in deep infection. Polymicrobial infection was identified in 38.5% and 80% of superficial and deep infections, respectively. Conclusion: Causative micro-organisms identified in both superficial and deep infection were similar to those reported in post-traumatic osteomyelitis. In an attempt to minimise infection, the treating clinician should focus on modifiable risk factors with adequate patient optimisation, prompt surgical treatment, adequate antibiotic coverage and wound care when treating patients with subtrochanteric femur fracture. MDPI 2021-07-28 /pmc/articles/PMC8347680/ /pubmed/34362123 http://dx.doi.org/10.3390/jcm10153331 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Panteli, Michalis
Vun, James S. H.
West, Robert M.
Howard, Anthony
Pountos, Ippokratis
Giannoudis, Peter V.
Surgical Site Infection Following Intramedullary Nailing of Subtrochanteric Femoral Fractures
title Surgical Site Infection Following Intramedullary Nailing of Subtrochanteric Femoral Fractures
title_full Surgical Site Infection Following Intramedullary Nailing of Subtrochanteric Femoral Fractures
title_fullStr Surgical Site Infection Following Intramedullary Nailing of Subtrochanteric Femoral Fractures
title_full_unstemmed Surgical Site Infection Following Intramedullary Nailing of Subtrochanteric Femoral Fractures
title_short Surgical Site Infection Following Intramedullary Nailing of Subtrochanteric Femoral Fractures
title_sort surgical site infection following intramedullary nailing of subtrochanteric femoral fractures
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8347680/
https://www.ncbi.nlm.nih.gov/pubmed/34362123
http://dx.doi.org/10.3390/jcm10153331
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