dc.contributor.author
Giesecke, Moritz T.
dc.contributor.author
Schwabe, Philipp
dc.contributor.author
Wichlas, Florian
dc.contributor.author
Trampuz, Andrej
dc.contributor.author
Kleber, Christian
dc.date.accessioned
2018-06-08T03:52:12Z
dc.date.available
2014-12-09T09:33:16.732Z
dc.identifier.uri
https://refubium.fu-berlin.de/handle/fub188/16099
dc.identifier.uri
http://dx.doi.org/10.17169/refubium-20284
dc.description.abstract
Introduction Emergency treatment of major sub-/total traumatic amputations
continue to represent a clinical challenge due to high infection rates and
serious handicaps. Effective treatment is based on two columns: surgery and
antimicrobial therapy. Detailed identification of pathogen spectrum and
epidemiology associated with these injuries is of tremendous importance as it
guides the initial empiric antibiotic regimen and prevents adverse septic
effents. Methods In this retrospective study 51 patients with major traumatic
amputations (n = 16) and subtotal amputations (n = 35) treated from 2001 to
2010 in our trauma center were investigated. All patients received emergency
surgery, debridement with microbiological testing within 6 h after admission
and empircic antimicrobial therapy. Additionally to baseline patient
characteristics, the incidence of positive standardized microbiologic testing
combined with clinical signs of infection, pathogen spectrum, administered
antimicrobial agents and clinical complications were analyzed. Results 70.6%
of the patients (n = 36) acquired wound infection. In 39% wounds were
contaminated on day 1, whereas the mean length of duration until first
pathogen detection was 9.1 ± 13.4 days after injury. In 37% polymicrobial
colonization and 28% Pseudomonas were responsible for wound infections during
hospitalization. In 45% the empirc antimicrobial therapy focussed on Gram
positive strains did not cover the detected bacteria, according antimicrobial
resistogram. It was significantly more often found in infections associated
with Pseudomonas (p 0.02) or polymicrobial wound infections. Conclusions This
epidemiologic study reveals a pathogen shift from Gram-positive to Gram-
negative strains with high incidence of Pseudomonas and polymicrobial
infections in sub-/total major traumatic amputations. Therefore, empiric
antimicrobial treatment historically focussing on Gram-positive strains must
be adjusted. We recommend the use of Piperacillin/Tazobactam for these
injuries. As soon as possible antimicrobial treatment should be changed from
empiric to goal directed therapy according to the microbiological tests and
resistogram results.
en
dc.rights.uri
http://creativecommons.org/licenses/by/4.0/
dc.subject.ddc
600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit
dc.title
Impact of high prevalence of pseudomonas and polymicrobial gram-negative
infections in major sub-/total traumatic amputations on empiric antimicrobial
therapy
dc.type
Wissenschaftlicher Artikel
dcterms.bibliographicCitation
World Journal of Emergency Surgery. - 9 (2014), 1, Artikel Nr.55
dc.title.subtitle
a retrospective study
dcterms.bibliographicCitation.doi
10.1186/1749-7922-9-55
dcterms.bibliographicCitation.url
http://www.wjes.org/content/9/1/55
refubium.affiliation
Charité - Universitätsmedizin Berlin
de
refubium.mycore.fudocsId
FUDOCS_document_000000021420
refubium.note.author
Der Artikel wurde in einer Open-Access-Zeitschrift publiziert
refubium.resourceType.isindependentpub
no
refubium.mycore.derivateId
FUDOCS_derivate_000000004234
dcterms.accessRights.openaire
open access