Risk Factors for Deep Surgical Site Infection in Patients With Operatively Treated Tibial Plateau Fractures: A Retrospective Multicenter Study.
Journal
Journal of orthopaedic trauma
ISSN: 1531-2291
Titre abrégé: J Orthop Trauma
Pays: United States
ID NLM: 8807705
Informations de publication
Date de publication:
01 07 2021
01 07 2021
Historique:
accepted:
05
11
2020
pubmed:
13
11
2020
medline:
22
6
2021
entrez:
12
11
2020
Statut:
ppublish
Résumé
To identify the potential controllable risk factors for surgical site infection (SSI). A retrospective cohort study. Seven Level-I trauma centers. Patients with OTA/AO 41 B or C tibial plateau fractures (n = 2106). Various surgical treatments for tibial plateau fractures. The primary outcome was SSI after the index operation. The secondary outcomes were the risk factors for SSI, identified using backward stepwise generalized multiple regression analysis. Of the 2106 enrolled patients, 94 had deep SSIs. The average SSI rate was 4.5%. Fracture morphology revealed type B injuries in 57.5% and type C in 42.5% of the patients. Univariate regression analysis revealed that several factors, namely, number of comorbidities [>6 vs. none; odds ratio (OR) 8.01, 95% confidence interval (CI) 2.8-22.8, P < 0.001], diabetes mellitus (OR 3.5, 95% CI 2.0-6.3, P < 0.001), high body mass index (OR 1.3, 95% CI 1.1-1.6, P = 0.001), OTA/AO fracture type C (OR 5.6, 95% CI 3.3-9.5, P < 0.001), compartment syndrome (OR 9.1, 95% CI 5.7-14.8, P < 0.001), and open fracture (OR 6.6, 95% CI 3.7-11.7, P < 0.001), were associated with a significantly higher SSI risk. Analysis of microbial sensitivity tests revealed that 55.1% of the pathogens were resistant to perioperative antibiotic prophylaxis. Most of the identified risk factors cannot be controlled or are subject to other factors that are difficult to control. However, our data suggest that the choice of perioperative antibiotic prophylaxis may influence the rate of SSI. This possibility should be investigated in a prospective randomized controlled trial. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Identifiants
pubmed: 33177429
pii: 00005131-202107000-00007
doi: 10.1097/BOT.0000000000002011
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
371-377Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflict of interest.
Références
Parkkinen M, Madanat R, Lindahl J, et al. Risk factors for deep infection following plate fixation of proximal tibial fractures. J Bone Joint Surg Am. 2016;98:1292–1297.
Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004;350:1422–1429.
Andersson AE, Bergh I, Karlsson J, et al. Patients' experiences of acquiring a deep surgical site infection: an interview study. Am J Infect Control. 2010;38:711–717.
Kirkland KB, Briggs JP, Trivette SL, et al. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20:725–730.
Badia JM, Casey AL, Petrosillo N, et al. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect. 2017;96:1–15.
Anderson DJ, Kaye KS. Staphylococcal surgical site infections. Infect Dis Clin North Am. 2009;23:53–72.
Poultsides LA, Ma Y, Della Valle AG, et al. In-hospital surgical site infections after primary hip and knee arthroplasty—incidence and risk factors. J Arthroplasty. 2013;28:385–389.
Gaunder CL, Zhao Z, Henderson C, et al. Wound complications after open reduction and internal fixation of tibial plateau fractures in the elderly: a multicentre study. Int Orthop. 2019;43:461–465.
Li J, Zhu Y, Liu B, et al. Incidence and risk factors for surgical site infection following open reduction and internal fixation of adult tibial plateau fractures. Int Orthop. 2018;42:1397–1403.
Momaya AM, Hlavacek J, Etier B, et al. Risk factors for infection after operative fixation of Tibial plateau fractures. Injury. 2016;47:1501–1505.
Norris GR, Checketts JX, Scott JT, et al. Prevalence of deep surgical site infection after repair of periarticular knee fractures: a systematic review and meta-analysis. JAMA Netw Open. 2019;2:e199951.
Weiner LM, Webb AK, Limbago B, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011–2014. Infect Control Hosp Epidemiol. 2016;37:1288–1301.
European Centre for Disease Prevention and Control. Healthcare-associated infections: surgical site infections. Annual Epidemiological Report for 2016. Stockholm, Sweden: ECDC; 2018.
KISS Krankenhaus-Infektions-Surveillance-System. Modul OP KISS, Referenzdaten, Berechnungszeitraum: January 2012 bis Dezember 2016; 2017. Available at: http://www.nrz-hygiene.de/fileadmin/nrz/module/op/201201_201612_OPRef.pdf . Accessed September 7, 2018.
Nationales Zentrum für Infektionsprävention, Swissnoso. Nationaler Vergleichsbericht Programm zur Überwachung Postoperativer Wundinfektionen; 2017. Available at: https://www.swissnoso.ch/fileadmin/module/ssi_surveillance/Dokumente_D/9_Resultate/20170904_SSI_Nationaler_Vergleichsbericht_2015_2016_Swissnoso.pdf . Accessed September 7, 2018.
Henkelmann R, Frosch KH, Glaab R, et al. Infection following fractures of the proximal tibia—a systematic review of incidence and outcome. BMC Musculoskelet Disord. 2017;18:481.
Baker SP, O'Neill B, Haddon W, et al. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–196.
Meinberg EG, Agel J, Roberts CS, et al. Fracture and dislocation classification compendium—2018. J Orthop Trauma. 2018;32:S1–S170.
Allegranzi B, Bischoff P, de Jonge S, et al. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16:e276–e287.
Allegranzi B, Zayed B, Bischoff P, et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16:e288–e303.
Centers for Disease Control and Prevention. Surgical Site Infection (SSI) Event. Procedure Associated Module: SSI. Available at: http://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf . Accessed September 7, 2018.
Kenward MG, Carpenter J. Multiple imputation: current perspectives. Stat Methods Med Res. 2007;16:199–218.
Dubina AG, Paryavi E, Manson TT, et al. Surgical site infection in tibial plateau fractures with ipsilateral compartment syndrome. Injury. 2017;48:495–500.
Nederpelt CJ, El Hechi M, Parks J, et al. The dose-dependent relationship between blood transfusions and infections after trauma: a population-based study. J Trauma Acute Care Surg. 2020;89:51–57.
Swiss Centre for Antibiotic Resistance. Antibiotikaresistenz. Available at: http://www.anresis.ch/index.php/interaktive-datenbankabfrage.html . Accessed September 20, 2018.
Niedersächsisches Landegesundheitsamt. ARMIN Interaktiv. Available at: https://www.nlga.niedersachsen.de/infektionsschutz/armin_resistenzentwicklung/armin_interaktiv/ . Accessed September 7, 2018.
Gillespie WJ, Walenkamp GH. Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures. Cochrane Database Syst Rev. 2010:CD000244.