Assessment of Severe Extremity Wound Bioburden at the Time of Definitive Wound Closure or Coverage: Correlation With Subsequent Postclosure Deep Wound Infection (Bioburden Study).
Infection remains the most common and significant complication after high-energy fractures. The Bioburden Study is a multicenter, prospective, observational cohort study of wound bacterial bioburden and antibiotic care in severe open lower extremity fractures. The aims of this study are to (1) characterize the contemporary extremity wound "bioburden" at the time of definitive wound closure; (2) determine the concordance between polymerase chain reaction results and hospital microbiology; (3) determine, among those who develop deep infections, the concordance between the pathogens at wound closure and at deep infection; and (4) compare the probability of deep infection between those who did and did not receive an appropriate course of antibiotics based on bioburden at the time of wound closure. To address these aims, sites collected tissue samples from severe lower extremity injuries at the time of wound closure and at first surgery for treatment of a deep infection, nonunion, flap failure, amputation, or other complications (because these surgeries may be due to undetected infection). Otherwise, if no further surgical treatment occurred, participants were followed for 12 months. The study was conducted at 38 US trauma centers and has enrolled 655 participants aged 18-64 years. This is the first large multi-institutional study evaluating the wound bioburden of severe open tibia fractures and correlating this bioburden with the risk of wound complications after definitive soft tissue closure.
*Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC; †U.S. Army, Uniformed Services University of the Health Sciences, San Antonio Military Medical Center, Infectious Disease Service, San Antonio, TX; ‡Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD; §Harborview Medical Center, University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, WA; ‖R Adams Cowley Shock Trauma Center, Department of Orthopaedics, Baltimore, MD; ¶Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD; **Extremity Trauma and Regenerative Medicine Task Area, United States Army Institute of Surgical Research, San Antonio, TX; and ††University of St. Augustine for Health Sciences, Occupational Therapy Program, Austin, TX.
Michael J
MJ
Bosse
Clinton K
CK
Murray
Anthony R
AR
Carlini
Reza
R
Firoozabadi
Theodore
T
Manson
Daniel O
DO
Scharfstein
Joseph C
JC
Wenke
Mary
M
Zadnik
Renan C
RC
Castillo
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D001458:Bandages / Q000382:microbiology; D015169:Colony Count, Microbial / Q000706:statistics & numerical data*; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013223:Statistics as Topic; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D013978:Tibial Fractures / Q000453:epidemiology / Q000382:microbiology* / Q000601:surgery*; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D058106:Wound Closure Techniques / Q000706:statistics & numerical data*; D055815:Young Adult
D000900:Anti-Bacterial Agents