Abstract
Aim
Management of infection after osteosynthesis (IAO) poses a significant challenge in the setting of multidrug resistant organisms (MDRo). We have analysed whether IAO with MDRo has an adverse outcome.
Method
We have retrospectively analysed patients with IAO from January 2001 to November 2016 with a minimum follow up of 12 months after the discontinuation of antibiotics.
Results
62 patients with a mean age of 49.76 years presenting a mean 135 days after onset of infection. 40 of them had associated comorbidities, commonest being diabetes mellitus. Majority of the patients were on empirical antibiotics prior to presentation.
Deep cultures taken after implant removal in all cases at our institute grew 77 organisms {25 Gram positive (Gm+), 52 Gram negative (Gm-)}, commonest being pseudomonas aeruginosa (n=32). 12 patients had a mixed Gm+ and Gm- infections. 41/ 77 organisms cultured were multi-drug resistant (MDR) (Table 1). Infection remission was achieved in 56 patients (90.3%) at a mean follow up of 42.2 months, with 1 persistent infection, 2 amputations and 3 deaths. Union was achieved in 47/51 non unions.
Conclusions
Radical debridement beyond infection with removal of implants, complemented by targeted local and systemic antibiotics along with a good soft tissue cover, surgical stabilization and bone grafting as needed can help achieve good results in spite of MDR organisms.
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