CD4 count is associated with postoperative infection in patients with orthopaedic trauma who are HIV positive.
BACKGROUND
Since the advent of effective antiretroviral therapy, the number of people with AIDS has increased and a certain percentage of these patients will require emergent orthopaedic surgery. Little is known regarding orthopaedic infections and the association of CD4 counts with postoperative infection in patients with HIV infection who experience orthopaedic trauma.


OBJECTIVE
We questioned whether the postoperative infection rate is higher after orthopaedic trauma surgery for patients who are HIV positive than for patients who are HIV negative undergoing similar surgery and aimed to identify preoperative variables that may be important in predicting postoperative infection in patients who are HIV positive.


METHODS
We determined the postoperative infection rate in 64 patients who were HIV positive and who underwent orthopaedic surgery requiring instrumentation or an implant from January 2001 to May 2007. We compared this rate with historical control data from 2003 to 2007 for all orthopaedic procedures at Grady Memorial Hospital. We examined numerous preoperative variables for association with postoperative infection, including CD4 count, length of inpatient stay, polytrauma, and malnutrition.


RESULTS
Of the 64 patients, 15 had postoperative infections develop with an infection rate of 23%, compared with the 3.9% rate for the historical control subjects. Analysis of the 64 patients who were HIV positive revealed CD4 counts less than 300 were associated with development of postoperative infection. Hospital stay, polytrauma, and low serum albumin also were found to be associated with postoperative infection.


CONCLUSIONS
It is evident that patients who are HIV positive with low CD4 counts undergoing emergent orthopaedic intervention are a patient population at risk for infection. Further study is necessary to evaluate preoperative and perioperative interventions that may decrease infections in this population.


METHODS
Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
Department of Orthopaedics, Emory University, 59 Executive Park South, Suite 2000, Atlanta, GA 30329, USA. gnguild@emory.edu
George N
GN
Guild
Thomas J
TJ
Moore
Whitney
W
Barnes
Christopher
C
Hermann
D000328:Adult; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology / Q000473:pathology*; D005260:Female; D006679:HIV Seropositivity / Q000150:complications / Q000276:immunology / Q000473:pathology*; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D013203:Staphylococcal Infections / Q000150:complications / Q000276:immunology / Q000473:pathology; D013530:Surgical Wound Infection / Q000150:complications / Q000276:immunology / Q000473:pathology*; D014947:Wounds and Injuries / Q000150:complications / Q000276:immunology / Q000473:pathology*