Sagi Henry Claude, Cooper Seth, Donahue David, Marberry Scott, Steverson Barbara
From the Orthopedic Trauma Service (H.C.S., B.S.), Florida Orthopedic Institute; and Department of Orthopedic Surgery (H.C.S., S.C., D.D.), University of South Florida, Tampa; and Foundation for Orthopaedic Trauma and Education (S.M.), Temple Terrace, Florida.
J Trauma Acute Care Surg. 2015 Dec;79(6):1073-8. doi: 10.1097/TA.0000000000000705.
The vast majority of the orthopedic trauma literature has dealt with risk of infection as a function of time to debridement and severity of open fracture. The goal of this analysis was to determine if either the incidence or causative organism of posttraumatic infection varies with the season in which the open fracture occurred. No such study has been previously published.
This is a retrospective chart review of all skeletally mature patients sustaining an open fracture of either the upper or the lower extremity long bones from 2007 to 2012. Charts were reviewed to extract information regarding date of injury, Gustilo-Anderson grade of open fracture, Injury Severity Score (ISS), time to surgical debridement, any posttraumatic wound infection (deep or superficial), and the causative organisms. Patients were placed into one of four groups based on the time of year: spring (March to May), summer (June to August), fall (September to November), and winter (December to February). Patients were excluded if they were skeletally immature, smokers, or also diagnosed with a condition that would increase risk of infection. Statistical analysis was performed to assess whether any observed differences were of significance.
All four groups were similar with respect to Gustilo grade, ISS, and time to surgical debridement. A total of 1,128 open fractures were treated between 2007 and 2012. There were 58 total infections for an overall incidence of 4.3%. The incidence of infection based on season was 6.0% for spring, 4.9% for summer, 2.8% for fall, and 3.6% for winter (p < 0.05). The incidence of infection was 5.5% for spring and summer combined and 3.9% for winter and fall combined (p < 0.05). Gram-positive organisms were more prevalent in the spring and summer seasons (p < 0.05). Although gram-negative organisms were cultured more commonly in the fall and winter seasons (52%) compared with the spring and summer seasons (36%), they were evenly distributed with gram-positive organisms during the winter and fall.
A seasonal variation exists regarding the incidence of infection and causative organisms for posttraumatic wound infection following open extremity fractures. The incidence of infection is significantly higher in the spring and summer months with a preponderance of gram-positive organisms. Patients with infection after injuries sustained in the fall and winter months are more likely to have a Gustilo Grade 3 injury and gram-negative bacteria as the causative organism.
Epidemiologic study, level III.
绝大多数骨科创伤文献都将感染风险视为清创时间和开放性骨折严重程度的函数。本分析的目的是确定创伤后感染的发生率或致病微生物是否随开放性骨折发生的季节而变化。此前尚未发表过此类研究。
这是一项对2007年至2012年期间所有上肢或下肢长骨发生开放性骨折的骨骼成熟患者的回顾性图表审查。审查图表以提取有关受伤日期、开放性骨折的 Gustilo-Anderson 分级、损伤严重程度评分（ISS）、手术清创时间、任何创伤后伤口感染（深部或浅表）以及致病微生物的信息。根据一年中的时间将患者分为四组之一：春季（3月至5月）、夏季（6月至8月）、秋季（9月至11月）和冬季（12月至2月）。如果患者骨骼未成熟、吸烟或还被诊断患有会增加感染风险的疾病，则将其排除。进行统计分析以评估任何观察到的差异是否具有显著性。
所有四组在 Gustilo 分级、ISS 和手术清创时间方面相似。2007年至2012年期间共治疗了1128例开放性骨折。总共有58例感染，总发生率为4.3%。按季节划分的感染发生率为春季6.0%，夏季4.9%，秋季2.8%，冬季3.6%（p < 0.05）。春季和夏季合并的感染发生率为5.5%，冬季和秋季合并的感染发生率为3.9%（p < 0.05）。革兰氏阳性菌在春季和夏季更为普遍（p < 0.05）。尽管与春季和夏季（36%）相比，革兰氏阴性菌在秋季和冬季更常培养到（52%），但它们在冬季和秋季与革兰氏阳性菌均匀分布。
开放性四肢骨折后创伤后伤口感染的发生率和致病微生物存在季节性变化。春季和夏季的感染发生率明显更高，革兰氏阳性菌占优势。在秋季和冬季受伤后感染的患者更有可能发生 Gustilo 3级损伤，且致病微生物为革兰氏阴性菌。
流行病学研究，III级。
