Post-traumatic bone and/or joint limb infections due to Clostridium spp.

摘要: Summary Background Clostridium spp. are saprophytic Gram-positive bacteria found in soil and capable of generating endospores. Spore germination occurs when environmental conditions favorable. can cause infections compound fractures deep wounds contaminated from micro-organisms. Hypothesis traffic-related injuries particularly severe events whose outcome is uncertain even with aggressive medical surgical treatment. Materials methods We retrospectively reviewed 12 patients (median age, 45 years) bone and/or joint complicating limb contamination extensive soft-tissue damage. Prophylactic amoxicillin-clavulanic acid therapy was administred, followed by emergency wound debridment lavage. Fracture fixation performed immediately nine (external four internal five) or at a later time on three patients. The immediate unfavourable all cases, requiring early reoperation after median 10 days (range, 5–25 days). Results Median to strain identification 14.5 5–160). All were polymicrobial. Surgical excision, hardware removal (in cases), antibiotic produced favourable one patient, no recurrence 2 years follow-up; the 11 delayed fracture union, septic non-union, impaired healing, chronic sinus tract drainage. Several second-line treatments used these patients: intramedullary nailing without grafting patients, failures; decortication two failure both; who had good outcome; induced membrane procedure described Masquelet whom outcomes. After follow-up 24 months 18–53 months), infection subsided eight remaining non-union. Discussion severe. diagnosis organism challenging. treatment difficult results unfavorable outcomes one-third cases. specimens an osteoarticular indicates need for extremely resection, as spore resistance may impair vivo efficacy antimicrobial agents. Level evidence IV (retrospective cohort study).