Fracture related infection complicating civilian ballistic wounds in the amasonian zone.

Abstract

Introduction: Fracture-Related Infections (FRI) are one of the most common complications of ballistic wounds sustained in military operations. There is very little data on ballistic wounds in civilians, especially FRIs. There is no data at all on FRIs in French Guiana, which has one of the highest rates of delinquency and gun ownership in France.

Patients and methods: We conducted a retrospective study, including patients admitted to Cayenne Hospital with civilian ballistic wounds. Patients with incomplete records were excluded. The following data were collected: wound location, infectious complications and microbiological documentation. Chi-squared tests were used for categorical variables, a Student's t-tests for continuous variables and a logistic regression for multivariate analysis.

Results: Of the 196 patients included in the study, the overall reported infection rate was 14%. FRIs were the most frequent infectious complication, occurring in 15% (14 out of 95 fractures caused by ballistic wounds). Of these, 53 were open fractures, 27 of which were classified as Gustilo ≥ 2. Six (43%) of the 14 FRIs were monomicrobial, including four methicillin-susceptible S. aureus. Eight (57%) were polymicrobial, seven of which had at least one Gram-negative bacillus in culture. Sixteen Gram-negative bacilli, including ten group 3 Enterobacteriaceae, were isolated from eight patients. The presence of an external fixator (adjusted odds ratio (aOR) [95% confidence interval (CI)]: 28.9 [5.9-139.9], p < 0.001) and comorbidity (diabetes, steroids or HIV) (aOR [95% CI]: 37.5 [4.5-308.4], p = 0.001) were significantly associated with FRI occurrence in the multivariate analysis.

Conclusion: FRIs are one of the most common complications from civilian ballistic wounds in French Guiana. FRIs are often polymicrobial, with a high prevalence of Gram-negative bacteria. FRIs are favored by comorbidities and the presence of an external fixator.