Acta Ortopédica Mexicana

Rincón-Cardozo DF, Sauza-Rodríguez N, Padilla-Rueda LC, Rincón-Cardozo PA, Díaz-Mantilla CO, Abril-Gaona CA
Prevalence and frequency of factors associated with infection in patients older than 18 years with closed fractures
Acta Ortop Mex 2016; 30 (3)

Language: Español
References: 43
Page: 123-131
PDF: 224.73 Kb.

[Fulltext - PDF]


Introduction: Surgical site infection (ISO) is the most common nosocomial infection and is a process associated with multiple factors, which together generate a condition that directly affects the welfare of the patient. Material and methods: Cross-sectional study, conducted over 1 year period, the sample size was established for all patients who met the inclusion criteria. An instrument takes the variables; double tabulation of patients is performed in Excel 2013 and data are analyzed in Stata version 11. Results: The average age was 44.3 ± 18.8 years and the male: female ratio is 1.7:1. Clinical features, lower limbs are the most affected and 21.9 % of cases affect the femur. A prevalence of 6.6 % was found, being the most common deep infection classification. Staphylococcus aureus was cultured in 38.5% of which 40% were methicillin sensible. Conclusion: ISO prevalence in patients with closed fractures in HUS is 6.6% higher compared with literature data. The findings of this study it was established that hemoglobin below 10 g/dl, transfusion, reoperation and surgical risk ASA were associated statistically with ISO.

Key words: Infection, surgery, fractures, incidence.


  1. Escarpanter BJ, Cruz SP, Alfonso RD. Sepsis nosocomial en ortopedia. Estudio de un año. Rev Cubana Ortop Traumatol. 1996; 10(1): 162-167.

  2. Maksimović J, Marković-Denić L, Bumbasirević M, Marinković J, Vlajinac H. Surgical site infections in orthopedic patients: prospective cohort study. Croat Med J. 2008; 49: 58-65.

  3. Suzuki T, Morgan SJ, Smith WR, Stahel PF, Gillani SA, Hak DJ. Postoperative surgical site infection following acetabular fracture fixation. Injury. 2010; 41(4): 396-9.

  4. Lee-Smith J. Can the orthopaedic team reduce the risk of infection? Journal of Orthopaedic Nursing. 1999; 2(2): 95-98.

  5. American Academy of Orthopaedic Surgeons Patient Safety Committee, Evans RP. Surgical Site Infection Prevention and Control: An Emerging Paradigm. J Bone Joint Surg Am. 2009; 91: 2-9.

  6. Jaeger M, Maier D, Kern WV, Südkamp NP. Antibiotics in trauma and orthopedic surgery-a primer of evidence-based recommendations. Injury. 2006; 37: S74-80.

  7. Gillespie WJ, Walenkamp G. Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures. Cochrane Database Syst Rev. 2001; (1): CD000244.

  8. Owens CD, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. J Hosp Infec. 2008; 70 (S2): 3-10.

  9. De Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: Incidence and impact on hospital utilization and treatment costs. Am J Infect Control. 2009; 37: 387-97.

  10. Del Gordo D’Amato RJ, Caballero QR, Daza HD, Vergara CJ. Infección del sitio operatorio en cirugía ortopédica y traumatológica en la Clínica el Prado de la ciudad de Santa Marta. Duazary 2009; 6(1): 25-3.

  11. Quintero A. Infección del sitio operatorio. Cáp. II. Servicio de microbiología quirúrgica. Departamento de Cirugía. Fundación Santa Fe. Bogotá D.C. 2006. 1070-1075.

  12. Espinal A. Incidencia de infecciones nosocomiales en pacientes quirúrgicos de ortopedia. Hospital escuela “Dr. Oscar Danilo Rosales A”. Universidad Nacional Autónoma de Nicaragua. Facultad de Ciencias Médicas; Marzo del 2004.

  13. Humphreys H. Preventing surgical site infection. Where now? J Hosp Infect. 2009; 73: 316-22.

  14. Campoccia D, Montanaro L, Arciola CR. The significance of infection related to orthopedic devices and issues of antibiotic resistance. Biomaterials. 2006; 27: 2331-9.

  15. Teterycz D, Ferry T, Lew D, Stern R, Assal M, Hoffmeyer P et al. Outcome of orthopedic implant infections due to different Staphylococci. Int J Infect Dis. 2010; 14: e913-8.

  16. Lee J, Singletary R, Schmader K, Anderson DJ, Bolognesi M, Kaye KS. Surgical site infection in the elderly following orthopaedic surgery. Risk factors and outcomes. J Bone Joint Surg Am. 2006; 88: 1705-12.

  17. Fletcher N, Sofianos D, Berkes MB, Obremskey WT. Prevention of perioperative infection. J Bone Joint Surg Am. 2007; 89: 1605-18.

  18. Moran E, Masters S, Berendt AR, McLardy-Smith P, Byren I, Atkins BL. Guiding empirical antibiotic therapy in orthopaedics: the microbiology of prosthetic joint infection managed by debridement, irrigation and prosthesis retention. J Infect. 2007; 55: 1-7.

  19. Rightmire E, Zurakowski D, Vrahas M. Acute Infections after fracture repair, management with hardware in place. Clin Orthop Relat Res. 2008; 466: 466-72.

  20. Nalini RA, Santa ER et al. Anti-infective therapy in orthopaedics. Operative Techniques in Orthopaedics. 2002; 12(4): 247-52.

  21. Uçkay I, Hoffmeyer P, Lew D, Pittet D. Prevention of surgical site infections in orthopaedic surgery and bone trauma: state-of-the-art update. Journal of Hospital Infection. 2013; 84: 5-12.

  22. Moriarty TF, Schlegel U, Perren S, Richards RG. Infection in fracture fixation: Can we influence infection rates through implant design? J Mater Sci Mater Med. 2010; 21: 1031-5.

  23. Szczêsny G, Interewicz B, Swoboda-Kopeć E, Olszewski WL, Górecki A, Wasilewski P. Bacteriology of callus of closed fractures of tibia and femur. J Trauma. 2008; 65: 837-42.

  24. Lin S, Mauffrey C, Hammerberg EM, Stahel PF, Hak DJ. Surgical site infection after open reduction and internal fixation of tibial plateau fractures. Eur J Orthop Surg Traumatol. 2013; 24(5): 797-803.

  25. Abalo A, Patassi A, James YE, Walla A, Sangare A, Dossim A. Risk factors for surgical wound infection in HIV-positive patients undergoing surgery for orthopaedic trauma. J Orthop Surg (Hong Kong). 2010; 18(2): 224-7.

  26. Shukla S, Nixon M, Acharya M, Korim MT, Pandey R. Incidence of MRSA surgical-site infection in MRSA carriers in an orthopaedic trauma unit. J Bone Joint Surg [Br]. 2009; 91-B: 225-8.

  27. Walaszek M, Zieńczuk W, Wolak Z, Dobroś W, Walaszek M. Surgical site infections in patients of orthopedic – trauma, unit in district hospital in 2008-2012. Przegl Epidemiol. 2013; 67: 439-44, 543-6.

  28. Saadatian-Elahi M1, Teyssou R, Vanhems P. Staphylococcus aureus, the major pathogen in orthopaedic and cardiac surgical site infections: a literature review. Int J Surg. 2008; 6: 238-245.

  29. Huotari K, Agthe N, Lyytikäinen O. Validation of surgical site infection surveillance in orthopedic procedures. Am J Infect Control. 2007; 35: 216-21.

  30. Cadwallader HL, Toohey M, Linton S, Dyson A, Riley TV. A comparison of two methods for identifying surgical site infections following orthopaedic surgery. J Hosp Infect. 2001; 48: 261-6.

  31. Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J et al. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am. 2008; 90: 62-9.

  32. Wukich DK, Lowery NJ, McMillen RL, Frykberg RG. Postoperative infection rates in foot and ankle surgery: a comparison of patients with and without diabetes mellitus. J Bone Joint Surg Am. 2010; 92: 287-95.

  33. Thu LT, Dibley MJ, Ewald B, Tien NP, Lam LD. Incidence of surgical site infections and accompanying risk factors in Vietnamese orthopaedic patients. J Hosp Infect. 2005; 60: 360-7.

  34. Parikh SN, Grice SS, Schnell BM, Salisbury SR. Operating room traffic: is there any role of monitoring it? J Pediatr Orthop. 2010; 30: 617-23.

  35. Knobben BA, van Horn JR, van der Mei HC, Busscher HJ. Evaluation of measures to decrease intra-operative bacterial contamination in orthopaedic implant surgery. J Hosp Infect. 2006; 62: 174-80.

  36. Morrison S, White N, Asadollahi S, Lade J. Single versus multiple doses of antibiotic prophylaxis in limb fracture surgery. ANZ J Surg. 2012; 82: 902-7.

  37. Thangarajah T, Prasad PS, Narayan B. Surgical site infections following open reduction and internal fixation of ankle fractures. Open Orthop J. 2009; 3: 56-60.

  38. Andersson AE, Bergh I, Karlsson J, Eriksson BI, Nilsson K. The application of evidence-based measures to reduce surgical site infections during orthopedic surgery - report of a single-center experience in Sweden. Patient Saf Surg. 2012; 6: 11

  39. Bachoura A, Guitton TG, Smith RM, Vrahas MS, Zurakowski D, Ring D. Infirmity and injury complexity are risk factors for surgical-site infection after operative fracture care. Clin Orthop Relat Res. 2011; 469: 2621-30.

  40. Lundine KM, Nelson S, Buckley R, Putnis S, Duffy PJ. Adherence to perioperative antibiotic prophylaxis among orthopedic trauma patients. Can J Surg. 2010; 53(6): 367-72.

  41. Richards JE, Kauffmann RM, Zuckerman SL, Obremskey WT, May AK. Relationship of hyperglycemia and surgical site infection in orthopaedic surgery. J Bone Joint Surg Am. 2012; 94: 1181-6.

  42. Slobogean GP, Kennedy SA, Davidson D, O’Brien PJ. Single- versus multiple-dose antibiotic prophylaxis in the surgical treatment of closed fractures: a meta-analysis. J Orthop Trauma. 2008; 22: 264-9.

  43. Wright A, Gruen G, Siska P, Pape HC, Tarkin I. Prolonged operative time increases infection rate in tibial plateau fractures. Injury. 2013; 44: 249-52.