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Deep Infections After Open and Closed Fractures
Michael Polmear1, Jennifer E Hagen1, Gregory M Schrank2
1University of Florida, Gainesville, Florida.
The Journal of Bone and Joint Surgery. American Volume
|June 18, 2025
Summary
Surgical site infections (SSIs) show high culture positivity rates. Open fractures have more gram-negative bacteria and polymicrobial infections, leading to earlier infection times. Deep-tissue cultures are recommended for suspected SSIs.
Area of Science:
- Microbiology
- Infectious Diseases
- Orthopedic Surgery
Background:
- Surgical site infections (SSIs) are a significant concern in patient care.
- Understanding the microbial landscape of SSIs is crucial for effective treatment.
Purpose of the Study:
- To analyze culture and speciation results from patients with surgical site infections (SSIs).
- To compare microbial findings between open and closed fractures in SSI cases.
Main Methods:
- Deep or organ tissue samples were collected from patients with suspected SSIs for microbial culture.
- Culture positivity rates and microbial species were quantified.
- Statistical analyses, including Z-tests for proportions and hazard ratios, were used to compare outcomes between fracture types and infection characteristics.
Main Results:
- A high culture positivity rate of 96.7% was observed in 484 SSI cases.
- Open fractures showed a higher likelihood of polymicrobial infections (47.8%) compared to closed fractures (36.8%).
- Staphylococcus aureus was the most common microbe. Gram-negative infections and polymicrobial infections were associated with a shorter median time to infection.
Conclusions:
- Deep-tissue cultures are highly effective in identifying pathogens in suspected SSIs.
- Open fractures present a greater risk of polymicrobial infections and earlier onset.
- Clinicians should consider the potential for polymicrobial infections and earlier infection timelines, particularly in open fractures.
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