title: What is the rate of methicillin-resistant Staphylococcus aureus and Gram-negative infections in open fractures?
abstract: BACKGROUND
  There have been increasing reports of methicillin-resistant Staphylococcus aureus (MRSA) infections in the community, but it is unclear whether infectious organisms in open fracture infections have changed and if our current regimen of antibiotic prophylaxis is therefore obsolete.
  
  
  OBJECTIVE
  We determined the recent incidence of MRSA and Gram-negative organism infections after open fractures.
  
  
  METHODS
  We performed a retrospective cohort study on 189 patients with 202 open fractures treated from 2009 to 2010. During the followup, patients were evaluated for signs of infection using the Centers for Disease Control and Prevention criteria. We determined the organisms using routine microbiology culture. The minimum followup was 3 months (median, 47 months; range, 3-108 months).
  
  
  RESULTS
  Of the 202 open fractures, 20 (10%) developed infections. The most common organism was Staphylococcus, whereas five (25%) of those infected were positive for MRSA, and 11 (55%) of those with infection were cultured for at least one Gram-negative organism. Six (30%) open fractures had infections that grew out multiple organisms. The incidence of MRSA infections in our open fracture population was 2.5%.
  
  
  CONCLUSIONS
  There is a high incidence of MRSA and Gram-negative infections after open fractures, which may indicate that current antibiotic regimens need to be changed.
  
  
  METHODS
  Level IV, retrospective case-series. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Mercy Professional Office Building, 1350 Locust Street Suite 220, Pittsburgh, PA, 15219, USA.
authors.forename: Antonia F
authors.initials: AF
authors.lastname: Chen
authors.forename: Verena M
authors.initials: VM
authors.lastname: Schreiber
authors.forename: Wesley
authors.initials: W
authors.lastname: Washington
authors.forename: Nalini
authors.initials: N
authors.lastname: Rao
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Evans
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D005597:Fractures, Open / Q000188:drug therapy / Q000382:microbiology*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
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