Abstract
Aim
Determine the incidence of surgical site infections (SSI) after intramedullary nailing (IN) of femoral and tibial diaphyseal fractures and evaluate possible risk factors.
Method
Prospective observational cohort study. SSI was defined according to CDC-NHSN criteria and surveillance period for the occurrence of infection was 12 months instead of the 90 days currently recommended. Incidence was calculated as the ratio between the number of patients with SSI and total number of patients. Analysis of potential risk factors included patients-related factors (age, gender, body mass index, active foci of infection, immunosuppressive conditions, ASA score, alcohol or illicit drug abuse, smoking, polytrauma, etiology of fracture, type of fracture if closed or open, classification of fracture according to Müller AO, Tcherne classification for closed fractures, Gustilo-Anderson classification and duration of bone exposure for open fractures, previous stay in other healthcare services, use of external fixator, previous surgical manipulation at same topography of fracture, use of blood products); environmental and surgical-related factors (surgical wound classification, duration of surgery, hair removal, intraoperative contamination, antimicrobial use, presence of drains, hypothermia or hypoxia in the perioperative period, type of IN used, reaming, need for muscle or skin flap repair, use of negative pressure therapy) and microbiota-related factors (presence of preoperative colonization by Staphylococcus aureus or Acinetobacter baumannii).
Results
221 patients were included and completed the 12-month follow-up period. Incidence of SSI was 11.8% after 12-month follow-up, but would be 8.59% if used the 90-day vigilance period currently recommended. In the initial analysis by unadjusted logistic regression, following factors were associated SSI: Müller AO classification of the fracture morphology groups 2 or 3, previous use of external fixator, presence of drains, use of negative pressure therapy and need for muscle or skin flap repair. Preoperative colonization by S. aureus or A. baumannii was not associated with occurrence of infection. In the multiple logistic regression-adjusted analysis, only previous use of external fixator and need for muscle or skin flap repair remained associated with SSI.
Conclusions
Incidence of SSI associated with IN for femoral and tibial diaphyseal fractures was 11.8%, but currently recommended vigilance period would be less sensitive for SSI detection after fracture fixation. Previous use of external fixators and need for muscle or skin flap repair were factors associated with occurrence of IN related infection.
