title: Effect of surgical delay on bacterial colonization in proximal humeral fractures.
abstract: Postoperative infection is a severe complication after proximal humeral fracture surgical treatment. The aim of this study was to determine if the surgical delay could modify the number and type of bacteria on the surgical site. A two stages study was set up. In the first stage the effect of delay was simulated in 20 patients affected by proximal humeral fracture treated conservatively. In a second stage, the effect of delay was measured in 20 patients that underwent surgery. In stage 1, three skin culture swabs were taken in correspondence of the deltopectoral approach, the day of the fracture (day 0), the day after (day 1), and five days after fracture (day 5). In stage 2, skin swab cultures were taken the day of trauma and immediately before surgery and cultured on various media suitable for aerobic and anaerobic bacteria. The number of bacteria increased over the course of the study, from day 0 to day 5, both considering the total number of colony-forming units and individual species of pathogen bacteria. The second stage of the study confirmed these data. An increasing number of bacteria was observed in patients that underwent surgery later than 2 days from trauma. The delay of surgery increased bacterial colonization of the skin in the deltopectoral approach area including common pathogenic bacteria such as Staphylococcus aureus, coagulase-negative staphylococci and Propionibacterium acnes. This might justify the correlation between delay to surgery and risk of infection. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:942-948, 2016.
authors.affiliation: Department of Orthopaedic and Traumatology, Mauriziano-Umberto I Hospital, University of Turin Medical School, Turin, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Blonna
authors.affiliation: Department of Orthopaedic and Traumatology, Mauriziano-Umberto I Hospital, University of Turin Medical School, Turin, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Barbasetti di Prun
authors.affiliation: Department of Orthopaedic and Traumatology, Mauriziano-Umberto I Hospital, University of Turin Medical School, Turin, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Bellato
authors.affiliation: Department of Orthopaedic and Traumatology, Mauriziano-Umberto I Hospital, University of Turin Medical School, Turin, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Manino
authors.affiliation: Department of Orthopaedic and Traumatology, Mauriziano-Umberto I Hospital, University of Turin Medical School, Turin, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rossi
authors.affiliation: Department of Public Health and Paediatrics, Microbiology Division, Città della Salute e della Scienza, University of Turin Medical School, Turin, Italy.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Banche
authors.affiliation: Department of Public Health and Paediatrics, Microbiology Division, Città della Salute e della Scienza, University of Turin Medical School, Turin, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Allizond
authors.affiliation: Department of Public Health and Paediatrics, Microbiology Division, Città della Salute e della Scienza, University of Turin Medical School, Turin, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Cuffini
authors.affiliation: Department of Orthopaedic and Traumatology, Città della Salute e della Scienza, CTO-Maria Adelaide Hospital, University of Turin Medical School, Turin, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Castoldi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000382:microbiology* / Q000601:surgery; D012867:Skin / Q000382:microbiology; D013997:Time Factors
keywords: Propionibacterium acnes; delay of surgery; infection; proximal humeral fracture; skin swab cultures