Skip to main content
SpringerLink
Log in

CD4 Count is Associated with Postoperative Infection in Patients with Orthopaedic Trauma who are HIV Positive

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Since the advent of effective antiretroviral therapy, the number of people with AIDS has increased and a certain percentage of these patients will require emergent orthopaedic surgery. Little is known regarding orthopaedic infections and the association of CD4 counts with postoperative infection in patients with HIV infection who experience orthopaedic trauma.

Questions/purposes

We questioned whether the postoperative infection rate is higher after orthopaedic trauma surgery for patients who are HIV positive than for patients who are HIV negative undergoing similar surgery and aimed to identify preoperative variables that may be important in predicting postoperative infection in patients who are HIV positive.

Methods

We determined the postoperative infection rate in 64 patients who were HIV positive and who underwent orthopaedic surgery requiring instrumentation or an implant from January 2001 to May 2007. We compared this rate with historical control data from 2003 to 2007 for all orthopaedic procedures at Grady Memorial Hospital. We examined numerous preoperative variables for association with postoperative infection, including CD4 count, length of inpatient stay, polytrauma, and malnutrition.

Results

Of the 64 patients, 15 had postoperative infections develop with an infection rate of 23%, compared with the 3.9% rate for the historical control subjects. Analysis of the 64 patients who were HIV positive revealed CD4 counts less than 300 were associated with development of postoperative infection. Hospital stay, polytrauma, and low serum albumin also were found to be associated with postoperative infection.

Conclusions

It is evident that patients who are HIV positive with low CD4 counts undergoing emergent orthopaedic intervention are a patient population at risk for infection. Further study is necessary to evaluate preoperative and perioperative interventions that may decrease infections in this population.

Level of Evidence

Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–B

Similar content being viewed by others

References

  1. Abdool Karim SS, Abdool Karim Q, Gouws E, Baxter C. Global epidemiology of HIV-AIDS. Infect Dis Clin North Am. 2007;21:1–17, vii.

    Article  PubMed  Google Scholar 

  2. Avidan MS, Groves P, Blott M, Welch J, Leung T, Pozniak A, Davies E, Ball C, Zuckerman M. Low complication rate associated with cesarean section under spinal anesthesia for HIV-1-infected women on antiretroviral therapy. Anesthesiology. 2002;97:320–324.

    Article  PubMed  Google Scholar 

  3. Buehrer JL, Weber DJ, Meyer AA, Becherer PR, Rutala WA, Wilson B, Smiley ML, White GC 2nd. Wound infection rates after invasive procedures in HIV-1 seropositive versus HIV-1 seronegative hemophiliacs. Ann Surg. 1990;211:492–498.

    Article  PubMed  CAS  Google Scholar 

  4. Centers for Disease Control and Prevention. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20(4):247–278.

    Google Scholar 

  5. Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumen as predictor of postoperative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. 1999;134:36–42.

    Article  PubMed  CAS  Google Scholar 

  6. Harrison WJ. HIV/AIDS in trauma and orthopaedic surgery. J Bone Joint Surg Br. 2005;87:1178–1181.

    Article  PubMed  CAS  Google Scholar 

  7. Harrison WJ, Lewis CP, Lavy CB. Open fractures of the tibia in HIV positive patients: a prospective controlled single-blind study. Injury. 2004;35:852–856.

    Article  PubMed  CAS  Google Scholar 

  8. Hoekman P, van de Perre P, Nelissen J, Kwisanga B, Bogaerts J, Kanyangabo F. Increased frequency of infection after open reduction of fractures in patients who are seropositive for human immunodeficiency virus. J Bone Joint Surg Am. 1991;73:675–679.

    PubMed  CAS  Google Scholar 

  9. Jones S, Schechter CB, Smith C, Rose DN. Is HIV infection a risk factor for complications of surgery? Mt Sinai J Med. 2002;69:329–333.

    PubMed  Google Scholar 

  10. Luck JV Jr, Hansraj KK, Griffin MD. Risk factors for late infection with total hip and knee arthroplasties. Presented at the 61st Annual Meeting of the American Academy of Orthopaedic Surgeons, New Orleans, LA, USA. February 26, 1994.

  11. Luck JV Jr, Logan LR, Benson DR, Glasser DB. Human immunodeficiency virus infection: complications and outcomes in orthopaedic surgery. J Am Acad Orthop Surg. 1996;4:297–304.

    PubMed  Google Scholar 

  12. Osborn JE. The past, present, and future of AIDS. JAMA. 2008;300:581–583.

    Article  PubMed  CAS  Google Scholar 

  13. Osmond DH. Epidemiology of HIV/AIDS in the United States. UCSF HIV InSite Knowledge Base Chapter March 2003. Available at: http://hivinsite.ucsf.edu/InSite?page=kb-01-03. Accessed August 15, 2011.

  14. Paiement GD, Hymes RA, LaDouceur MS, Gosselin RA, Green HD. Postoperative infections in asymptomatic HIV-seropositive orthopedic trauma patients. J Trauma. 1994;37:545–550; discussion 550–551.

    Article  PubMed  CAS  Google Scholar 

  15. Tran HS, Moncure M, Tarnoff M, Goodman M, Puc MM, Kroon D, Eydelman J, Ross SE. Predictors of operative outcome in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome. Am J Surg. 2000;180:228–233.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

We thank Andrea Knezevic BS, for her contribution to the biostatistical analysis of this work.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Grady Memorial Hospital, Atlanta, GA, USA

    Thomas J. Moore MD

  2. Department of Orthopaedics, Emory University, 59 Executive Park South, Suite 2000, Atlanta, GA, 30329, USA

    George N. Guild MD, Thomas J. Moore MD, Whitney Barnes MPH, BS & Christopher Hermann BS

Authors
  1. George N. Guild MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas J. Moore MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Whitney Barnes MPH, BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christopher Hermann BS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to George N. Guild MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no 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, all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This study was performed at Grady Memorial Hospital, Atlanta, GA, USA.

About this article

Cite this article

Guild, G.N., Moore, T.J., Barnes, W. et al. CD4 Count is Associated with Postoperative Infection in Patients with Orthopaedic Trauma who are HIV Positive. Clin Orthop Relat Res 470, 1507–1512 (2012). https://doi.org/10.1007/s11999-011-2223-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-011-2223-1

Keywords

Search

Navigation