Abstract
With the rising prevalence of HIV, the number of immunocompromised patients is increasing. Higher rates of wound sepsis following implant surgery in seropositive patients have been anecdotally reported in Central and East Africa, but at any single institution experience with HIV and implant surgery is limited.
This is a review of 21 patients, 18 of whom were seropositive, who had infected implants after undergoing elective operations for fractures that presented late (mean time 24 months). In 16 patients radiological union had occurred and the septic implants were removed. The organisms cultured in these patients were Staphylococcus aureus and Group-A Streptococcus. In 14 of the patients, implant removal and antibiotics produced excellent results. Two required a Girdlestone excision of the hip and gentamycin beads. Incision and drainage was performed in three patients who had superficial sepsis. The organism cultured was Group-A Streptococcus. All wounds healed. One patient died of AIDS: aspirate revealed Escherichia coli with mixed organisms. In one patient the organism was Pseudomonas aeruginosa and after the nail was removed the patient had a persistent draining sinus.
The results suggest that HIV-positive patients are at increased risk of postoperative infection, and that early removal of implants may avoid future septic complications.
The abstracts were edited by Prof. M.B.E. Sweet. Correspondence should be addressed to him at the Department of Orthopaedic Surgery, Medical School, University of the Witwatersrand, 7 York Road, Parktown, 2193 South Africa
