Bacterial Epidemiology of Surgical Site Infections after Open Fractures of the Lower Limb: A Retrospective Cohort Study

Tracie Joyner Youbong,Sylvain Diamantis,Coralie Noel,Samir Sayegh,Clara Flateau,Aurélia Pitsch,Maxence Rouyer,Abdelmalek Abbadi,Alessio Strazzula,Astrid De Pontfarcy,Catherine Chakvetadze

doi:10.3390/antibiotics10121513

Tracie Joyner Youbong, Sylvain Diamantis + Show 9 more

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https://doi.org/10.3390/antibiotics10121513

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Journal: Antibiotics	Publication Date: Dec 10, 2021
Citations: 2	License type: CC BY 4.0

Affiliation: Melun Hospital, Université Paris-Est Créteil

Abstract

Open lower limb fractures are common injuries, and the occurrence of infectious complications after open fractures is a usual problem. The rate of surgical site infections (SSIs) and the nature and resistance of the germs responsible for SSIs remain poorly described. Our aim was to describe the bacterial epidemiology of SSIs after surgical management of an open lower limb fracture. We conducted a retrospective monocentric cohort study from 1 January 2012 to 31 December 2020 based on the analysis of inpatient records in a non-university hospital of Ile de France region. All patients who underwent surgery for an open lower limb fracture were included. A total of 149 patients were included. In our population, 19 (12.7%) patients developed an SSI. Of these 19 patients, the sample was polymicrobial in 9 (47.4%) patients. In 9 (45%) cases, the samples identified a group 3 enterobacteria, Enterobacter cloacae being the main one in 7 (36.9%) cases. Staphylococci were identified in 11 patients, with Staphylococcus aureus in 9 (47.4%). All Staphylococcus aureus were susceptible to methicillin, and all enterobacteria were susceptible to C3G. Among all SSI, 10 (58.8%) contained at least one germ resistant to amoxicillin/clavulanic acid (AMC). The SSIs rate was 12.7%. The main pathogens identified were Enterobacter cloacae and Staphylococcus aureus. The presence of early SSI caused by group 3 Enterobacteriaceae renders current antibiotic prophylaxis protocols inadequate with AMC in half the cases.

Highlights

Open fractures of the lower extremity are common injuries after high-energy trauma.They require urgent surgeries of Altemeier contamination class 3 or 4 depending on the time to surgery
Regarding risk factors for SSI, our study identified diabetes as the only factor associated with the occurrence of surgical site infections
Its monocentric nature leads to a bias related to local epidemiology, which is different according to regions and countries

Summary

Introduction

Open fractures of the lower extremity are common injuries after high-energy trauma. They require urgent surgeries of Altemeier contamination class 3 or 4 depending on the time to surgery. Altemeier contamination classes 3 and 4 correspond to contaminated and septic surgeries, respectively [1]. In his study, identified the association between certain types of open fractures and the frequency of surgical site infections involving different pathogens [2]. The Gustilo–Anderson classification of open fractures was used to guide prophylactic and preemptive antibiotic therapy. Infectious complications following open fractures are a common issue, with rates ranging from

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