Infection following treatment of mandible fractures: the role of immunosuppression and polysubstance abuse.
OBJECTIVE
There is little data available on the relationship between immunosuppression and polysubstance abuse and postoperative infection in patients with mandibular fractures. In this study we aimed to assess these parameters.


METHODS
This study sample consisted of 120 patients who were admitted to the Department of Oral and Maxillofacial Surgery at the Washington Hospital Center between January of 1999 and February of 2002. Patient charts were reviewed and data regarding fracture location, mode of treatment, type of antibiotic therapy, and outcome of treatment including postoperative complications were also recorded. Patient's medical and social histories were also reviewed for a history of diabetes mellitus (DM), human immunodeficiency virus (HIV) status, alcohol abuse, and intravenous drug abuse (IVDA).


RESULTS
Of the 120 patients in this study, 17 (14.1%) patients were identified as having a postoperative infection. Among those with postoperative infections, 8 (6.7%) had history of immunosuppression or polysubstance abuse. The strongest association found in this review is the relationship between alcohol (P = 0.50) and IVDA (P = 0.68), and the development of post-operative infections. There was also an increased rate of postoperative infection in HIV-positive patients (P = 0.71) and DM patients (P = 0.77).


CONCLUSIONS
In our study, we observed an increased risk for post-operative infection in HIV-positive individuals and diabetics. This finding lends support to other studies, which have shown a higher incidence of infection in HIV-positive individuals. We also observed an increased risk for postoperative infection among patients with history of alcohol and drug abuse. Therefore, in treatment planning for the correction of mandible fractures in patients with histories of substance abuse, it seems appropriate to make efforts to decrease the postoperative risk.
Senel
Figen Cizmeci
FC
Department of Oral and Maxillofacial Surgery, Washington Hospital Center, Washington, DC, USA.
Jessen
Gregory S
GS
Melo
Maico D
MD
Obeid
George
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications; D016009:Chi-Square Distribution; D048909:Diabetes Complications; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008337:Mandibular Fractures / Q000601:surgery*; D008875:Middle Aged; D016017:Odds Ratio; D015819:Substance Abuse, Intravenous / Q000150:complications; D019966:Substance-Related Disorders / Q000150:complications*; D013530:Surgical Wound Infection / Q000209:etiology*