Impact of bacterial identification in surgery treatment of lower limb open fractures

• Grant number: 14/00008-4
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: April 01, 2014
• End date: December 31, 2014
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Mauro José Costa Salles
• Grantee: Isabela Carolina de Paula
• Host Institution: Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP). Fundação Arnaldo Vieira de Carvalho. São Paulo , SP, Brazil

Abstract

Open fractures often present severe complications, such as post traumatic osteomyelitis, responsible for high morbidity rates. This complication is the first cause of amputation due to open fracture and may evolve into a chronic osteomyelitis, with incapacitating lesions to the patient. The treatment protocol of open fractures considers that community bacteria have a low resistance profile to antibiotics, and, therefore, culture collection is not always done and valued in the patient's admission. However, multiresistant communitary bacteria are frequent and the coverage of empiric antibiotics may not be guaranteed. The aim of this study is to verify the impact of culture collection and bacterial identification in first surgery of open fractures treatment to guide antibiotic therapy in the prevention of post-traumatic osteomyelitis. It includes patients with lower limb open fractures, Gustilo type II and III, treated in the Emergency Orthopedic Service of Santa Casa de São Paulo. All patients will receive debridement, fracture stabilization and empiric antibiotic therapy. They will be divided randomly in two groups, and only one group will have bone and soft tissue collected for culture in the first surgery of open fracture treatment. In this group, there will be a change in the antibiotic therapy in accordance to the sensibility pattern of the pathogenic agent found in the culture. Orthopedic infection will be compared between the groups in the early phase (60 days) and in the later phase (1 year).