Fate of Patients With a 'Surprise' Positive Culture After Nonunion Surgery
| Autor: | Martin F. Hoffmann, William M. Ricci, Dana C Olszewski, Paul Tornetta, Clifford B. Jones, Philipp N. Streubel, Charlton Stucken, Debra L. Sietsema |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Prosthesis-Related Infections Adolescent medicine.drug_class Nonunion Antibiotics Population Comorbidity 03 medical and health sciences Fracture Fixation Internal Young Adult 0302 clinical medicine Fracture fixation Prevalence Medicine Humans Orthopedics and Sports Medicine 030212 general & internal medicine Young adult education Fractures Malunited Aged Retrospective Studies Aged 80 and over 030222 orthopedics education.field_of_study Bone Transplantation business.industry Incidence (epidemiology) Retrospective cohort study General Medicine Bacterial Infections Middle Aged medicine.disease United States Surgery Anti-Bacterial Agents Causality Chronic infection Treatment Outcome Female business |
| Zdroj: | Journal of orthopaedic trauma. 30(1) |
| ISSN: | 1531-2291 |
| Popis: | Objective Review the impact of unexpected positive cultures from definitive surgery for nonunion regarding postoperative treatment and ultimate result. Designs Retrospective multicenter case series. Setting Three level-one trauma centers. Patients Six-hundred sixty-six consecutive nonunions were treated during the study period. Four-hundred fifty-three cases (68%) were considered at risk for indolent infection (prior open fracture, surgery, or infection) and had cultures taken at the time of definitive surgery. Intervention Intraoperative cultures during definitive operative treatment of nonunions. Main outcome measurement The incidence of "surprise" positive cultures was determined, and the course of the patients was documented including the use of antibiotics, surgery performed, and the outcome regarding infection and union. Results Ninety-one (20%) cases had a surprise positive culture despite negative inflammatory markers. Most of bacteria isolated from the cultures were Staphylococcus species. Eight (9%) of the ninety-one cultures were considered probable contaminants and no antibiotics were given, 5 of these patients healed. The other 83 patients were treated with antibiotics, initially 66 (80%) healed and 12 (14%) remained infected. Eighty-two percent of patients with augmentation healed as compared with 86% of those not grafted. Conclusions The treatment of nonunions is challenging, and in patients with a history of surgery or open fracture, we found that 20% had positive intraoperative cultures from the definitive surgery. We recommend intraoperative cultures for all patients undergoing revision surgery. The use of culture-specific antibiotics is justified based on the overall low rate of infection in this complex population and the high rate of chronic infection (25%) for those treated as contaminants. Patients may be counseled that a positive culture after nonunion surgery is a treatable problem but does increase the risk of infection and additional surgery as compared with those with a negative intraoperative culture. Level of evidence Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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