Skin, soft tissue, bone and joint infections in trauma patients during rehabilitation

Infections are a frequent complication of military trauma, occurring not only in the acute phase but also during rehabilitation. However, studies specifically addressing infections in the rehabilitation setting remain scarce. This study aimed to evalu-ate the incidence, microbiological spectrum, treatment approaches, and outcomes of skin and soft tissue infections (SSTIs) and bone and joint infections (BJIs) in military trauma patients during inpatient rehabilitation.

We retrospectively reviewed the medical records of military trauma patients hospitalized at a tertiary rehabilitation hospital between January 2020 and June 2023. Patients who developed SSTIs or BJIs during rehabilitation were included. Demographic and clinical characteristics, laboratory and imaging findings, culture results, antibiotic regimens, surgical interventions, treatment duration, and recurrence rates were analyzed.

Among 1,078 trauma patients, 58 (5.4%) developed SSTIs or BJIs. Stump infection was the most frequent type (44.8%), followed by graft infection (15.5%). Staphylococcus species were the predominant pathogens, while multidrug-resistant (MDR) gram-negative organisms were isolated in 24.1% of cases. β-lactam/β-lactamase inhibitor (BL-BLI) therapy was the most common mono-therapy, whereas BL-BLI plus a fluoroquinolone was the most frequently used combination regimen. Surgical intervention was required in 34.5% of patients. Recurrent infections occurred in 25.8% of cases. Treatment duration was significantly longer in non-amputee pa-tients (p<0.05), primarily due to bone and joint infections. Despite these infectious complications, most lower-limb amputees achieved ambulatory status with prosthetic devices.

Military trauma patients remain at risk for SSTIs and BJIs during rehabilitation, with stump infections being the most common. The emergence of MDR organisms underscores the need for appropriate antibiotic selection and strict infection control measures. Despite these complications, relatively favorable functional outcomes can be achieved, particularly in younger trauma populations, highlighting the value of comprehensive rehabilitation programs.