Journal Article

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

Pradhan, Chetan, Sprague, Sheila, Bhandari, Mohit, Doshi, Prakash, Kulkarni, Sunil, Gopalan, Hitesh

2017

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Anti-Bacterial Agents - administration & dosage / Anti-Bacterial Agents - therapeutic use / Antibiotic resistance / Antibiotics / Bone healing / Bone surgery / Closed tibia fractures / Cohort analysis / Delayed Diagnosis / Epidemiology / Female / Follow-Up Studies / Fracture Fixation, Internal - adverse effects / Fracture Healing / Fractures / Fractures (Injuries) / Fractures, Closed - diagnosis / Fractures, Closed - surgery / Fractures, Open - diagnosis / Fractures, Open - surgery / Health aspects / Hematology / Hospitals / Humans / Incidence / India - epidemiology / Infections / Internal fixation / Internal Medicine / Male / Medicine / Medicine & Public Health / Middle Aged / Musculoskeletal diseases / Observational studies / Open tibia fractures / Orthopedics / Orthopedics and biomechanics / Patients / Prospective Studies / Public health / Quality of Life / Rehabilitation / Research Article / Rheumatology / Risk factors / Sports Medicine / Surgery / Surgical Wound Infection - drug therapy / Surgical Wound Infection - epidemiology / Surgical Wound Infection - prevention & control / Tibia / Tibial Fractures - diagnosis / Tibial Fractures - surgery / Time Factors / Time-to-Treatment / Trauma / Urbanization / Wound infection