Bosse Michael J, Murray Clinton K, Carlini Anthony R, Firoozabadi Reza, Manson Theodore, Scharfstein Daniel O, Wenke Joseph C, Zadnik Mary, Castillo Renan C
*Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC; †U.S. Army, Uniformed Services University of the Health Sciences, San Antonio Military Medical Center, Infectious Disease Service, San Antonio, TX; ‡Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD; §Harborview Medical Center, University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, WA; ‖R Adams Cowley Shock Trauma Center, Department of Orthopaedics, Baltimore, MD; ¶Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD; **Extremity Trauma and Regenerative Medicine Task Area, United States Army Institute of Surgical Research, San Antonio, TX; and ††University of St. Augustine for Health Sciences, Occupational Therapy Program, Austin, TX.
J Orthop Trauma. 2017 Apr;31 Suppl 1:S3-S9. doi: 10.1097/BOT.0000000000000805.
Infection remains the most common and significant complication after high-energy fractures. The Bioburden Study is a multicenter, prospective, observational cohort study of wound bacterial bioburden and antibiotic care in severe open lower extremity fractures. The aims of this study are to (1) characterize the contemporary extremity wound "bioburden" at the time of definitive wound closure; (2) determine the concordance between polymerase chain reaction results and hospital microbiology; (3) determine, among those who develop deep infections, the concordance between the pathogens at wound closure and at deep infection; and (4) compare the probability of deep infection between those who did and did not receive an appropriate course of antibiotics based on bioburden at the time of wound closure. To address these aims, sites collected tissue samples from severe lower extremity injuries at the time of wound closure and at first surgery for treatment of a deep infection, nonunion, flap failure, amputation, or other complications (because these surgeries may be due to undetected infection). Otherwise, if no further surgical treatment occurred, participants were followed for 12 months. The study was conducted at 38 US trauma centers and has enrolled 655 participants aged 18-64 years. This is the first large multi-institutional study evaluating the wound bioburden of severe open tibia fractures and correlating this bioburden with the risk of wound complications after definitive soft tissue closure.
感染仍然是高能骨折后最常见且最严重的并发症。生物负荷研究是一项关于严重开放性下肢骨折伤口细菌生物负荷及抗生素治疗的多中心、前瞻性观察队列研究。本研究的目的是：（1）在伤口最终闭合时描述当代肢体伤口的“生物负荷”特征；（2）确定聚合酶链反应结果与医院微生物检测结果之间的一致性；（3）在发生深部感染的患者中，确定伤口闭合时的病原体与深部感染时的病原体之间的一致性；（4）比较根据伤口闭合时的生物负荷接受或未接受适当疗程抗生素治疗的患者发生深部感染的概率。为实现这些目标，各研究点在伤口闭合时以及首次因深部感染、骨不连、皮瓣坏死、截肢或其他并发症（因为这些手术可能是由于未被发现的感染所致）进行手术治疗时，采集严重下肢损伤的组织样本。否则，如果没有进行进一步的手术治疗，则对参与者进行12个月的随访。该研究在美国38个创伤中心开展，已招募了655名年龄在18至64岁之间的参与者。这是第一项评估严重开放性胫骨骨折伤口生物负荷并将该生物负荷与确定性软组织闭合后伤口并发症风险相关联的大型多机构研究。
