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Incidence of infection following internal fixation of open and closed tibia fractures in India (INFINITI): a multi-centre observational cohort study

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus

EQ-5D over time. Open-No Infection coincides with Closed-No Infection. Mean EQ-5D was used as a measure of health outcome over 12 months post-surgery
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Fig2: EQ-5D over time. Open-No Infection coincides with Closed-No Infection. Mean EQ-5D was used as a measure of health outcome over 12 months post-surgery

Mentions: The mean time to fracture healing was 171.5 ± 88.4 days for open fractures and the majority (83.5%) had healed by 12 months. The mean fracture healing time for closed fractures was 145.5 ± 68.2 days and 91.0% had healed by 12 months. Fractures that were infected took 223.0 ± 102.6 days to radiographically heal, whereas fractures that were not infected took 149.0 ± 72.0 days to heal (p = 0.0234) (Table 5). Approximately half (56.5%) of the infected fractures were radiographically healed at 12 months, compared to almost all non-infected fractures (88.2%) (p < 0.0001) (Table 5). Participants who had an open fracture and an infection had the lowest EQ-5D scores at 6 months and 12 months (p < 0.0001) and their scores did not return to baseline at 12 months (Fig. 2).Fig. 2


Incidence of infection following internal fixation of open and closed tibia fractures in India (INFINITI): a multi-centre observational cohort study
EQ-5D over time. Open-No Infection coincides with Closed-No Infection. Mean EQ-5D was used as a measure of health outcome over 12 months post-surgery
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5391577&req=5

Fig2: EQ-5D over time. Open-No Infection coincides with Closed-No Infection. Mean EQ-5D was used as a measure of health outcome over 12 months post-surgery
Mentions: The mean time to fracture healing was 171.5 ± 88.4 days for open fractures and the majority (83.5%) had healed by 12 months. The mean fracture healing time for closed fractures was 145.5 ± 68.2 days and 91.0% had healed by 12 months. Fractures that were infected took 223.0 ± 102.6 days to radiographically heal, whereas fractures that were not infected took 149.0 ± 72.0 days to heal (p = 0.0234) (Table 5). Approximately half (56.5%) of the infected fractures were radiographically healed at 12 months, compared to almost all non-infected fractures (88.2%) (p < 0.0001) (Table 5). Participants who had an open fracture and an infection had the lowest EQ-5D scores at 6 months and 12 months (p < 0.0001) and their scores did not return to baseline at 12 months (Fig. 2).Fig. 2

View Article: PubMed Central - PubMed

ABSTRACT

Background: Trauma is a major public health problem, particularly in India due to the country&rsquo;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&nbsp;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&nbsp;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&nbsp;days for closed fractures and 9.1&nbsp;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.

No MeSH data available.


Related in: MedlinePlus