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Microbiology in the Low-Resource Environment

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Orthopaedic Trauma in the Austere Environment

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Abstract

In resource-limited settings, trauma-related infections are often avoidable, but only a balanced approach between appropriate pharmacological treatment and a meticulous surgical technique will prevent them. Infection must be considered a clinical event modulated by microbe-related (toxins, enzymes, virulence) and host-related risk factors (poor hygiene, malnutrition, impaired immunity). Mechanisms of injury and the amount of transferred energy are strongly related to the occurrence of infections. The first contamination of a wound, usually by Clostridia and β-hemolytic streptococcus, is followed by a self-contamination from the skin, gastrointestinal flora, and by hospital acquired infection, therefore emphasizing the role of hygiene and environmental control measures. The organisms contaminating an open fracture on presentation do not necessarily represent the microbes that will eventually cause infection, mostly triggered by multiple drug-resistant nosocomial bacteria. The utility of tissue cultures is controversial. Severe acute post-traumatic infections, such as gas gangrene, tetanus, necrotizing fasciitis, and myonecrosis, are considered more in details. Antimicrobial cover should be considered an adjunct to a proper wound care and never a solution for poor surgical management. Antibiotic coverage should be given as soon as possible, but there is no clear evidence about how long it should be administered and which is the best antibiotic. A realistic approach in austere environment is likely to be an immediate delivery of penicillin or cefazolin as soon as possible after trauma, with Gram-negative coverage in the presence of major wounds, or of a delay more than 72 h. Preparation to surgery, wound irrigation, and dressing play an important role in the occurrence of infections. Common systemic infections in developing countries, like HIV, hepatitis B and C, and tuberculosis, and their relation to trauma are also considered.

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  1. Department of Surgical Sciences, Parma University Hospital, Parma, Italy

    Sandro Contini MD

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    Juan de Dios Robinson

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Contini, S. (2016). Microbiology in the Low-Resource Environment. In: Robinson, J. (eds) Orthopaedic Trauma in the Austere Environment. Springer, Cham. https://doi.org/10.1007/978-3-319-29122-2_21

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