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What is the Rate of Methicillin-resistant Staphylococcus aureus and Gram-negative Infections in Open Fractures?

  • Symposium: 2012 Musculoskeletal Infection Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

There have been increasing reports of methicillin-resistant Staphylococcus aureus (MRSA) infections in the community, but it is unclear whether infectious organisms in open fracture infections have changed and if our current regimen of antibiotic prophylaxis is therefore obsolete.

Questions/Purposes

We determined the recent incidence of MRSA and Gram-negative organism infections after open fractures.

Methods

We performed a retrospective cohort study on 189 patients with 202 open fractures treated from 2009 to 2010. During the followup, patients were evaluated for signs of infection using the Centers for Disease Control and Prevention criteria. We determined the organisms using routine microbiology culture. The minimum followup was 3 months (median, 47 months; range, 3–108 months).

Results

Of the 202 open fractures, 20 (10%) developed infections. The most common organism was Staphylococcus, whereas five (25%) of those infected were positive for MRSA, and 11 (55%) of those with infection were cultured for at least one Gram-negative organism. Six (30%) open fractures had infections that grew out multiple organisms. The incidence of MRSA infections in our open fracture population was 2.5%.

Conclusions

There is a high incidence of MRSA and Gram-negative infections after open fractures, which may indicate that current antibiotic regimens need to be changed.

Level of Evidence

Level IV, retrospective case-series. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Dana Farrell for her help with obtaining institutional review board and CARe approval.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Mercy Professional Office Building, 1350 Locust Street Suite 220, Pittsburgh, PA, 15219, USA

    Antonia F. Chen MD, MBA, Verena M. Schreiber MD, Wesley Washington & Andrew R. Evans MD

  2. Department of Medicine, Division of Infectious Disease, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Nalini Rao MD

Authors
  1. Antonia F. Chen MD, MBA
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  2. Verena M. Schreiber MD
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  3. Wesley Washington
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  4. Nalini Rao MD
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  5. Andrew R. Evans MD
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Corresponding author

Correspondence to Andrew R. Evans MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

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Chen, A.F., Schreiber, V.M., Washington, W. et al. What is the Rate of Methicillin-resistant Staphylococcus aureus and Gram-negative Infections in Open Fractures?. Clin Orthop Relat Res 471, 3135–3140 (2013). https://doi.org/10.1007/s11999-013-2855-4

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  • DOI: https://doi.org/10.1007/s11999-013-2855-4

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