title: The incidence and consequences of early wound infection after internal fixation for trauma in HIV-positive patients.
abstract: We report a prospective single-blind controlled   study of the incidence of early wound infection after internal fixation for   trauma in 609 patients, of whom 132 were HIV-positive. Wounds were   assessed for healing using the ASEPSIS score. There was no significant   difference in the rate of infection between HIV-positive and HIV-negative   patients undergoing clean surgery (4.2% vs 6%,   respectively; p = 0.65). HIV-positive patients did not receive additional antibiotic   prophylaxis or antiretroviral therapy as part of their management.   The difference in the rate of infection between HIV-positive and   HIV-negative patients with an open fracture or other contamination   was not significant (33% vs 15%, respectively;   p = 0.064). There was no relationship between CD4 count and infection   rate. HIV status did not significantly influence the number of secondary   surgical procedures (p = 0.183) or the likelihood of developing   chronic osteomyelitis (p = 0.131). Although previous contamination   from the time of injury was a risk factor for infection in mal-   and nonunions, it was not significantly increased in HIV-positive   patients (p = 0.144). We conclude that clean implant surgery in HIV-positive patients   is safe, with no need for additional prophylaxis.
authors.affiliation: University of Malawi, Department of Surgery, College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi. jbates@malawi.net
authors.forename: J
authors.initials: J
authors.lastname: Bates
authors.forename: N
authors.initials: N
authors.lastname: Mkandawire
authors.forename: W J
authors.initials: WJ
authors.lastname: Harrison
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D015984:Causality; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data*; D050723:Fractures, Bone / Q000453:epidemiology* / Q000601:surgery*; D005599:Fractures, Ununited / Q000453:epidemiology / Q000601:surgery; D006679:HIV Seropositivity / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016037:Single-Blind Method; D013530:Surgical Wound Infection / Q000453:epidemiology*