Determination of pathogens in deep surgical site infections following sinus tarsi approach calcaneal fracture surgery via open reduction internal fixation or primary arthrodesis - Implications for prophylaxis and treatment.

Abstract

High rates of surgical site infections (SSI) have been reported after calcaneal fracture surgery. The aims of the current study were to re-evaluate the rate of deep SSIs after ORIF of displaced intra-articular calcaneal fractures via the sinus tarsi approach, to identify different types of bacteria in the first obtained cultures and to determine the accuracy of the initially started (empiric) antibiotics prior to the results of the cultures. A search was performed from August 2012 to December 2023 using the specific surgical code for this procedure. Besides subject and surgery characteristics, the occurrence of deep SSI, the causative pathogens, and subsequent treatment strategies were documented. A total of 391 patients were screened for wound complications, among these patients fifteen deep SSI were found after a sinus tarsi approach (STA) (3.4%). The median age of patients was 57 (IQR 22) years, the majority of these patients identified as male (n=13, 87%) and were smokers (n=10, 67%). The most prevalent microorganisms were Staphylococcus aureus (present in 73.3% of cultures) and Enterobacter cloacae complex (present in 53.3% of cultures). Eight patients had infections with multiple species of microorganisms. Given the fact that an Staphylococcus aureus and/or Enterobacter cloacae complex were present in more than half of the cultures, we recommend targeting empiric antibiotic treatment at both gram-positive and gram-negative microorganisms once a deep SSI is suspected after calcaneal fracture surgery.