Incidence of infection following internal fixation of open and closed tibia fractures in India (INFINITI): a multi-centre observational cohort study
Abstract Background Trauma is a major public health problem, particularly in India due to the country’s rapid urbanization. Tibia fractures are a common and often complicated injury that is at risk of infection following surgical fixation. The primary objectives of this cohort study were to determin...
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| Format: | Article |
| Language: | English |
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BMC
2017-04-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12891-017-1506-4 |
| _version_ | 1818179160172920832 |
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| author | Prakash Doshi Hitesh Gopalan Sheila Sprague Chetan Pradhan Sunil Kulkarni Mohit Bhandari |
| author_facet | Prakash Doshi Hitesh Gopalan Sheila Sprague Chetan Pradhan Sunil Kulkarni Mohit Bhandari |
| author_sort | Prakash Doshi |
| collection | DOAJ |
| description | Abstract Background Trauma is a major public health problem, particularly in India due to the country’s rapid urbanization. Tibia fractures are a common and often complicated injury that is at risk of infection following surgical fixation. The primary objectives of this cohort study were to determine the incidence of infection within one year of surgery and to describe the distribution of infections by location and time of diagnosis for tibia fractures in India. Methods We conducted a multi-center, prospective cohort study. Patients who presented with an open or closed tibia fracture treated with internal fixation to one of the participating hospitals in India were invited to participate in the study. Participants attended follow-up visits at 3, 6, and 12 months post-surgery, where they were assessed for infections, fracture healing, and health-related quality of life as measured by the EurQol-5 Dimensions (EQ-5D). Results Seven hundred eighty-seven participants were included in the study and 768 participants completed the 12 month follow-up. The overall incidence of infection was 2.9% (23 infections). The incidence of infection was 1.6% (10 infections) in closed and 8.0% (13 infections) in open fractures. There were 7 deep and 16 superficial infections, with 5 being early, 7 being delayed, and 11 being late infections. Intra-operative antibiotics were given to 92.1% of participants and post-operative antibiotics were given to 96.8% of participants. Antibiotics were prescribed for an average of 8.3 days for closed fractures and 9.1 days for open fractures. Infected fractures took significantly longer to heal, and participants who had an infection had significantly lower EQ-5D scores. Conclusions The incidence of infection within this cohort is similar to those seen in developed countries. The duration of prophylactic antibiotic use was longer than standard practice in North America, raising concern for the potential development of antibiotic resistant microbes within Indian orthopaedic settings. Future research should aim to identify the best practice for antibiotic use in India to ensure that antibiotic usage patterns do not lead to unnecessary overuse, while maintaining a low incidence of infection. Trial registration NCT01691599 , September 17, 2012. |
| first_indexed | 2024-12-11T20:59:27Z |
| format | Article |
| id | doaj.art-57d0963561c24ba4a4a49c314d3d5398 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-11T20:59:27Z |
| publishDate | 2017-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-57d0963561c24ba4a4a49c314d3d53982022-12-22T00:51:01ZengBMCBMC Musculoskeletal Disorders1471-24742017-04-0118111010.1186/s12891-017-1506-4Incidence of infection following internal fixation of open and closed tibia fractures in India (INFINITI): a multi-centre observational cohort studyPrakash Doshi0Hitesh Gopalan1Sheila Sprague2Chetan Pradhan3Sunil Kulkarni4Mohit Bhandari5Division of Orthopaedic Surgery, McMaster UniversityDivision of Orthopaedic Surgery, McMaster UniversityDivision of Orthopaedic Surgery, McMaster UniversityDivision of Orthopaedic Surgery, McMaster UniversityDivision of Orthopaedic Surgery, McMaster UniversityDivision of Orthopaedic Surgery, McMaster UniversityAbstract Background Trauma is a major public health problem, particularly in India due to the country’s rapid urbanization. Tibia fractures are a common and often complicated injury that is at risk of infection following surgical fixation. The primary objectives of this cohort study were to determine the incidence of infection within one year of surgery and to describe the distribution of infections by location and time of diagnosis for tibia fractures in India. Methods We conducted a multi-center, prospective cohort study. Patients who presented with an open or closed tibia fracture treated with internal fixation to one of the participating hospitals in India were invited to participate in the study. Participants attended follow-up visits at 3, 6, and 12 months post-surgery, where they were assessed for infections, fracture healing, and health-related quality of life as measured by the EurQol-5 Dimensions (EQ-5D). Results Seven hundred eighty-seven participants were included in the study and 768 participants completed the 12 month follow-up. The overall incidence of infection was 2.9% (23 infections). The incidence of infection was 1.6% (10 infections) in closed and 8.0% (13 infections) in open fractures. There were 7 deep and 16 superficial infections, with 5 being early, 7 being delayed, and 11 being late infections. Intra-operative antibiotics were given to 92.1% of participants and post-operative antibiotics were given to 96.8% of participants. Antibiotics were prescribed for an average of 8.3 days for closed fractures and 9.1 days for open fractures. Infected fractures took significantly longer to heal, and participants who had an infection had significantly lower EQ-5D scores. Conclusions The incidence of infection within this cohort is similar to those seen in developed countries. The duration of prophylactic antibiotic use was longer than standard practice in North America, raising concern for the potential development of antibiotic resistant microbes within Indian orthopaedic settings. Future research should aim to identify the best practice for antibiotic use in India to ensure that antibiotic usage patterns do not lead to unnecessary overuse, while maintaining a low incidence of infection. Trial registration NCT01691599 , September 17, 2012.http://link.springer.com/article/10.1186/s12891-017-1506-4Closed tibia fracturesOpen tibia fracturesWound infection |
| spellingShingle | Prakash Doshi Hitesh Gopalan Sheila Sprague Chetan Pradhan Sunil Kulkarni Mohit Bhandari Incidence of infection following internal fixation of open and closed tibia fractures in India (INFINITI): a multi-centre observational cohort study BMC Musculoskeletal Disorders Closed tibia fractures Open tibia fractures Wound infection |
| title | Incidence of infection following internal fixation of open and closed tibia fractures in India (INFINITI): a multi-centre observational cohort study |
| title_full | Incidence of infection following internal fixation of open and closed tibia fractures in India (INFINITI): a multi-centre observational cohort study |
| title_fullStr | Incidence of infection following internal fixation of open and closed tibia fractures in India (INFINITI): a multi-centre observational cohort study |
| title_full_unstemmed | Incidence of infection following internal fixation of open and closed tibia fractures in India (INFINITI): a multi-centre observational cohort study |
| title_short | Incidence of infection following internal fixation of open and closed tibia fractures in India (INFINITI): a multi-centre observational cohort study |
| title_sort | incidence of infection following internal fixation of open and closed tibia fractures in india infiniti a multi centre observational cohort study |
| topic | Closed tibia fractures Open tibia fractures Wound infection |
| url | http://link.springer.com/article/10.1186/s12891-017-1506-4 |
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