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. 2024 Oct 1;7(4):e345.
doi: 10.1097/OI9.0000000000000345. eCollection 2024 Dec.

Deep infections after low-velocity ballistic tibia fractures are frequently polymicrobial and recalcitrant

Nainisha Chintalapudi  1 , Brianna R Fram  1 , Susan Odum  1 , Rachel B Seymour  1 , Madhav A Karunakar  1 ; EMIT; Joseph R Hsu, Laurence Kempton, Kevin Phelps, Stephen Sims, Suman Medda, Juliette Sweeney, Kate Hickson, Catherine Young, Priyanka Kamath
Affiliations

Deep infections after low-velocity ballistic tibia fractures are frequently polymicrobial and recalcitrant

Nainisha Chintalapudi et al. OTA Int. .

Abstract

Objectives: To identify risk factors for developing a fracture-related infection in operatively treated ballistic tibia fractures and to report the microbiologic results of intraoperative cultures.

Design: Retrospective review.

Setting: Level 1 trauma center.

Patients/participants: One hundred thirty-three adults with operatively treated low-velocity ballistic tibia fractures, from 2011 to 2021.

Intervention: One dose of prophylactic cefazolin or equivalent as well as perioperative prophylaxis.

Main outcome measurements: Deep infection rate.

Results: The deep infection rate was 12% (16/134) with no significant difference in injury characteristics, index surgical characteristics, or time to antibiotics between the groups (P > 0.05). Patients who were slightly older (35.5 vs. 27 median years, P = 0.005) and with higher median body mass indexes (BMIs) (30.09 vs. 24.51, P = 0.021) developed a deep infection. 56.3% of patients presented with signs of infection within the first 100 days after injury. Nine patients had polymicrobial infections. There were 29 isolated organisms, 69% were uncovered by first-generation cephalosporin prophylaxis (anaerobes, gram-negative rods, Enterococcus, methicillin resistant Staphylococcus Aureus [MRSA]), and 50% of patients developed recalcitrant infection and required a second reoperation where 6 organisms were isolated, half of which were not covered by first-generation prophylaxis (Enterococcus, Staphylococcus Aureus MRSA).

Conclusions: We found a deep infection rate of 12% among ballistic tibia fractures receiving standard-of-care antibiotic prophylaxis. Increased age and body mass index were associated with deep infections. Half became recalcitrant requiring a second reoperation. 66.7% of isolated organisms were not covered by first-generation cephalosporin prophylaxis. Consideration should be given to treatment options such as broader prophylaxis or local antibiotic treatment.

Level of evidence: IV.

Keywords: ballistic; infections; tibia fractures.

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Conflict of interest statement

Dr. Brianna R. Fram reports paid consulting for Synthes. Dr. Joseph R. Hsu reports consultancy and speaker fees for Stryker, consultancy for Globus Medical, speaker fees from Smith & Nephew speakers' bureau, speaker fees from Integra Lifesciences, and speaker fees from Depuy/Synthes. The remaining authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Isolated organisms from first reoperation.
Figure 2.
Figure 2.
Isolated organisms from second reoperation.
Figure 3.
Figure 3.
Overall isolated organisms.
See this image and copyright information in PMC

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