rifampin and Tibial-Fractures

Pin tract infection is a frequent complication of external fixation; according to literature its frequency ranges from 2-30%. The recent introduction of silver coating of polymeric materials was found to decrease bacterial adhesion; its clinical use with Foley catheters and central venous catheters led to significant results. To verify the ability of the same silver coating to decrease the bacterial colonization on external fixation screws, a prospective randomized study was carried out on 24 male patients; a total of 106 screws were implanted in the lower limb to fix femoral or tibial diaphyseal fractures: 50 were coated with silver and 56 were commercially available stainless steel screws. Although the coated screws resulted in a lower rate of positive cultures (30.0%) than the uncoated screws (42.9%), this difference was not statistically significant (p = 0.243). The clinical behavior of the coated screws did not differ from that of the uncoated ones. Furthermore, the implant of silver-coated screws resulted in a significant increase in the silver serum level. These results led us to consider it ethically unacceptable to continue this investigation.

Topics: Adolescent; Adult; Antibiotic Prophylaxis; Bacillus; Bacteria; Bone Nails; Corynebacterium; Enterococcus faecalis; External Fixators; Femoral Fractures; Humans; Male; Middle Aged; Prosthesis Design; Rifampin; Silver; Staphylococcus; Surgical Wound Infection; Tibial Fractures

We report 3 clinical cases of septic nonunions of lower limb long bones in which the pathogenicity of Propionibacterium acnes was retained after several weeks of poor outcome. The patients had fractures that were treated by internal fixation, without initially suspected infection. The diagnosis of delayed union coincided with the onset of treatment. Support was performed in 2 steps, allowing for the collection of several deep samples that were referred for microbiological analysis. Molecular techniques for microbiological investigation were performed on perioperative samples and were not contributive. The detection of P acnes, which was identified after several days of incubation, prompted us to consider the role of this bacterium. The presence of P acnes is regularly interpreted as contamination of samples during collection or handling in the laboratory. A multidisciplinary decision to make the diagnosis of surgical site infection with P acnes and specific antibiotic treatment for several months led to consolidation in all the patients. The ability of bacteria of the genus Propionibacterium to cause insidious surgical site infections should not be underestimated, and more extensive sample incubation is essential to diagnose such infections.

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Fracture Fixation, Internal; Fracture Healing; Fractures, Ununited; Humans; Lower Extremity; Middle Aged; Propionibacterium acnes; Rifampin; Surgical Wound Infection; Tibial Fractures; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Appendicitis; Drug Therapy, Combination; Enterocolitis; Humans; Male; Nafcillin; Neutropenia; Osteomyelitis; Prosthesis-Related Infections; Rifampin; Staphylococcal Infections; Tibial Fractures