Current bacterial speciation and antibiotic resistance in deep infections after operative fixation of fractures.
OBJECTIVE
Infection after fracture fixation is a major source of morbidity. Information regarding bacterial speciation and antibiotic resistance is lacking. We attempted to determine the speciation and drug resistance profiles associated with fracture fixation infections.


METHODS
Retrospective study.


METHODS
Level I trauma center.


METHODS
Two hundred eleven patients with 214 infections underwent surgery for postoperative infection from December 2006 to December 2010. Deep postoperative infections within 12 months of fixation were included.


METHODS
None.


METHODS
Incidence of each bacterial species and rate of clinically relevant resistance in Staphylococcus aureus, gram-negative rod (GNR), and Enterococcus species. The effect of timing of infection presentation and location of fracture on bacterial speciation was also investigated.


RESULTS
Fifty-six percent of infections had S. aureus present, with 58% of those (32% of all infections) being methicillin-resistant S. aureus. Thirty-two percent of infections had at least one GNR present, with only 4% of those being multidrug resistant. We found a marked increase in the rate of GNR infections of the pelvis, acetabulum, and proximal femur (63%) compared with other locations (27%), which was statistically significant (P = 0.0002).


CONCLUSIONS
At our center, S. aureus and GNR are most often found in deep postoperative infections after fixation. Methicillin-resistant S. aureus is common in this population. Our GNR rate is high, but resistance in this group was low. The proportion of GNR infections in the pelvis, acetabulum, and proximal femur was high even in closed fractures. These data provide a modern snapshot of orthopaedic infections after fracture fixation and might be useful in designing future studies and protocols for antibiotic prophylactic treatment. We are considering the use of aminoglycosides in the treatment of closed fractures of the pelvis, acetabulum, and proximal femur.


METHODS
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
*Department of Orthopaedics and †Division of Infectious Disease, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
Jesse T
JT
Torbert
Manjari
M
Joshi
Adrienne
A
Moraff
Paul E
PE
Matuszewski
Amanda
A
Holmes
Andrew N
AN
Pollak
Robert V
RV
OʼToole
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000209:etiology / Q000382:microbiology* / Q000503:physiopathology; D024881:Drug Resistance, Bacterial; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000209:etiology / Q000382:microbiology* / Q000503:physiopathology; D055815:Young Adult