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Variations in the Organisms Causing Deep Surgical Site Infections in Fracture Patients at a Level I Trauma Center (2006−2015)

Montalvo, Ryan N., BS*; Natoli, Roman M., MD, PhD; O’Hara, Nathan N., MHA; Schoonover, Carrie, BS*; Berger, Peter Z., BS*; Reahl, G. Bradley, BS*; Shirtliff, Mark E., PhD; Manson, Theodore T., MD*; Torbert, Jesse T., MD§; O’Toole, Robert V., MD*; Joshi, Manjari, MD

doi: 10.1097/BOT.0000000000001305
Original Article: PDF Only

Objectives: To quantify the current bacteriology of deep surgical site infections (SSI) after fracture surgery at 1 institution and to compare those data with historical controls at the same institution, assessing variations in infecting organisms over the past decade.

Design: Retrospective review.

Setting: Level I trauma center.

Patients/Participants: Two hundred forty-three patients requiring surgical intervention for deep SSI between January 2011 and December 2015 were compared with 211 patients requiring surgical intervention for deep SSI between December 2006 and December 2010.

Intervention: None.

Main Outcome Measurements: Bacteria were categorized as Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus, Enterococcus, Gram-negative rods (GNR), Gram-positive rods, anaerobes, or negative cultures. The proportion of each bacterial type was determined and compared with previously published data from the same trauma center (December 2006–December 2010).

Results: Patients most commonly had S. aureus infections (48%), followed by GNR (40%) and CoNS (19%). The proportion of CoNS species (26% versus 12%, P < 0.01) in infected patients was significantly higher during the current study period compared with historical controls. The proportion of S. aureus species in infected patients was significantly less during the current study period (39% versus 56%, P < 0.01). The reduction in the proportion of S. aureus species in infected patients was driven by a decrease in the proportion of methicillin-resistant S. aureus (MRSA) in the overall sample.

Conclusions: Bacteriology of deep SSI of fractures has changed substantially over the past decade at our center, specifically the proportions of GNR, CoNS, and MRSA.

*R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD;

Department of Orthopaedics, Indiana University Health Methodist Hospital, Indianapolis, IN;

Department of Microbial Pathogenesis, School of Dentistry, University of Maryland, Baltimore, MD;

§Department of Orthopaedics, Chippenham Hospital, Richmond, VA; and

R Adams Cowley Shock Trauma Center, Division of Infectious Disease, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD.

Corresponding author: Robert V. O’Toole, MD, R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, T3R62, Baltimore MD 21201, Tel: 410.328.6292, Fax: 410.328.2893, E-mail: rvo3@yahoo.com

Conflicts of Interest and Source of Funding: Dr. Shirtliff reports publishing royalties from UptoDate, research support from MedImmune, and holding stock in CelerDx, Diffusion, and Serenta; Dr. Manson reports receiving consulting fees from Global Medical, Smith & Nephew, and Stryker, and research support from DePuy Synthes; Dr. O’Toole reports royalties from CoorsTek, receiving consulting fees from CoorsTek, Imagen, and Smith & Nephew, research support from Stryker and Synthes, and holding stock in Imagen; Dr. Joshi reports receiving consulting fees from Pfizer. The authors report no other potential conflict of interest relevant to this article. No outside funding was received for this work.

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