Distribution of pathogens and risk factors for post-replantation wound infection in patients with traumatic major limb mutilation

Chang Gao; Haiyan Wang; Jihui Ju; Keran Zhang; Ye Gao; Shiqi Guo; Di Yin; Ruixing Hou; Qiang Guo

doi:10.1371/journal.pone.0301353

Distribution of pathogens and risk factors for post-replantation wound infection in patients with traumatic major limb mutilation

PLoS One. 2024 Apr 1;19(4):e0301353. doi: 10.1371/journal.pone.0301353. eCollection 2024.

Authors

Chang Gao^{1

2

3}, Haiyan Wang³, Jihui Ju⁴, Keran Zhang⁵, Ye Gao⁶, Shiqi Guo³, Di Yin³, Ruixing Hou⁴, Qiang Guo^{1

2

7}

Affiliations

¹ Department of Emergency and Critical Care Medicine, The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou, Jiangsu, China.
² Medical Center of Soochow University, Suzhou, Jiangsu, China.
³ Medical College of Soochow University, Suzhou, Jiangsu, China.
⁴ Department of Orthopaedic, Suzhou Ruihua Orthopaedic Hospital (Suzhou Ruixing Medical Group), Suzhou, Jiangsu, China.
⁵ Department of Critical Care Medicine, Suzhou Ruihua Orthopaedic Hospital (Suzhou Ruixing Medical Group), Suzhou, Jiangsu, China.
⁶ Department of Critical Care Medicine, Taicang Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
⁷ The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.

Abstract

Purpose: Even though replantation of limb mutilation is increasing, postoperative wound infection can result in increasing the financial and psychological burden of patients. Here, we sought to explore the distribution of pathogens and identify risk factors for postoperative wound infection to help early identification and managements of high-risk patients.

Methods: Adult inpatients with severed traumatic major limb mutilation who underwent replantation from Suzhou Ruixing Medical Group between November 09, 2014, and September 6, 2022 were included in this retrospective study. Demographic, and clinical characteristics, treatments, and outcomes were collected. Data were used to analyze risk factors for postoperative wound infection.

Results: Among the 249 patients, 185 (74.3%) were males, the median age was 47.0 years old. Postoperative wound infection in 74 (29.7%) patients, of whom 51 (20.5%) had infection with multi-drug resistant bacteria. Ischemia time (OR 1.31, 95% CI 1.13-1.53, P = 0.001), wound contamination (OR 6.01, 95% CI 2.38-15.19, P <0.001), and stress hyperglycemia (OR 23.37, 95% CI 2.30-236.93, P = 0.008) were independent risk factors, while the albumin level after surgery (OR 0.94, 95% CI 0.89-0.99, P = 0.031) was significant associated with the decrease of postoperative wound infection. Ischemia time (OR 1.21, 95% CI 1.05-1.40, P = 0.010), wound contamination (OR 8.63, 95% CI 2.91-25.57, P <0.001), and MESS (OR 1.32, 95% CI 1.02-1.71, P = 0.037 were independent risk factors for multi-drug resistant bacteria infection.

Conclusions: Post-replantation wound infection was common in patients with severe traumatic major limb mutilation, and most were multi-drug resistant bacteria. Ischemia time and wound contamination were associated with the increase of postoperative wound infection, including caused by multi-drug resistant. Positive correction of hypoproteinemia and control of stress hyperglycemia may be beneficial.

Copyright: © 2024 Gao et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

MeSH terms

Adult
Female
Humans
Hyperglycemia* / etiology
Ischemia / etiology
Limb Salvage
Lower Extremity / surgery
Male
Middle Aged
Replantation / adverse effects
Retrospective Studies
Risk Factors
Surgical Wound Infection* / epidemiology
Surgical Wound Infection* / etiology
Treatment Outcome

Grants and funding

Qiang Guo was supported by the Jinji Lake Talent Program, Suzhou Medical Health Technology innovation project (Grant No. SKY2022014), and innovative development of biomedicine in the Free Trade Zone (Grant No. SZM2021006). Chang Gao was supported by the innovative development of biomedicine in the Free Trade Zone (Grant No. SZM2023014). The funding sources did not have any involvement in the in the design of the study and collection, analysis, and interpretation of data or in writing the manuscript.