OWN - NLM
DA - 20170410
LR - 20170417
IS - 1557-8674 (Electronic)
IS - 1096-2964 (Linking)
VI - 18
IP - 3
DP - 2017 Apr
TI - Impact of Body Mass Index and Bacterial Resistance in Osteomyelitis after
Antibiotic Prophylaxis of Open Lower-Extremity Fractures.
PG - 368-373
LID - 10.1089/sur.2016.219 [doi]
AB - BACKGROUND: We investigated the clinical effectiveness of antimicrobial
prophylaxis in lower-extremity open fractures following the Eastern Association
for the Surgery of Trauma Guidelines. METHODS: This observational, retrospective,
single-center study included adults with lower-extremity open fractures of the
ankle, tibia, fibula, or femur. The primary endpoint was the incidence of
osteomyelitis within 12 months of the fracture. Secondary endpoint comparisons
were the time of antibiotic initiation and drug selection. RESULTS: A total of 90
patients were included. Patients suffered from Gustilo and Anderson grades I
(14%), II (54.7%), and III (31.3%) fractures. Almost all patients received
cefazolin (98%). Among grade III fractures, 59.3% (16/27) of patients received
additional gram-negative coverage as recommended by the guidelines. The
osteomyelitis rate was 8.9%. There was no difference in osteomyelitis rates among
patients with grade III fractures who received or did not receive additional
gram-negative coverage: 18.8% (3/16) and 0 (0/11) (p = 0.248), respectively.
There was no correlation between median antibiotic start time or antibiotic stop
time after closure and the development of osteomyelitis, respectively. Resistant
organisms caused 50% (4/8) of the osteomyelitis cases. On univariate analysis,
obesity had the most significant association with osteomyelitis (p = 0.026).
CONCLUSIONS: Bacterial resistance was common among cases of osteomyelitis in our
cohort. Obesity was associated with a higher rate of osteomyelitis.
FAU - Bremmer, Derek
AU - Bremmer D
AD - 1 Western Pennsylvania Hospital , Pittsburgh, Pennsylvania.
FAU - Bookstaver, Brandon
AU - Bookstaver B
AD - 2 College of Pharmacy, University of South Carolina , Columbia, South Carolina.
FAU - Cairns, Mark
AU - Cairns M
AD - 3 UNC Healthcare , Chapel Hill, North Carolina.
FAU - Lindley, Kenneth
AU - Lindley K
AD - 4 St. Luke's Regional Health System , Nampa, Idaho.
FAU - Durkin, Martin
AU - Durkin M
AD - 5 Palmetto Health , Columbia, South Carolina.
FAU - Koon, David
AU - Koon D
AD - 6 Palmetto Health/USC Medical Group, Columbia, South Carolina.
FAU - Quidley, April Miller
AU - Quidley AM
AD - 7 Vidant Medical Center , Greenville, North Carolina.
LA - eng
PT - Journal Article
PT - Observational Study
DEP - 20170227
PL - United States
TA - Surg Infect (Larchmt)
JT - Surgical infections
JID - 9815642
SB - IM
MH - Adult
MH - Aged
MH - Aged, 80 and over
MH - Antibiotic Prophylaxis/*methods
MH - *Body Mass Index
MH - *Drug Resistance, Bacterial
MH - Female
MH - Fractures, Open/*complications
MH - Humans
MH - Incidence
MH - Lower Extremity/*injuries
MH - Male
MH - Middle Aged
MH - Osteomyelitis/*epidemiology/*prevention & control
MH - Retrospective Studies
MH - Risk Factors
EDAT- 2017/04/11 06:00
MHDA- 2017/04/18 06:00
CRDT- 2017/04/11 06:00
AID - 10.1089/sur.2016.219 [doi]
PST - ppublish
SO - Surg Infect (Larchmt). 2017 Apr;18(3):368-373. doi: 10.1089/sur.2016.219. Epub
2017 Feb 27.