Assessment of Severe Extremity Wound Bioburden at the Time of Definitive Wound Closure or Coverage: Correlation With Subsequent Postclosure Deep Wound Infection (Bioburden Study)

J Orthop Trauma. 2017 Apr;31 Suppl 1:S3-S9. doi: 10.1097/BOT.0000000000000805.


Infection remains the most common and significant complication after high-energy fractures. The Bioburden Study is a multicenter, prospective, observational cohort study of wound bacterial bioburden and antibiotic care in severe open lower extremity fractures. The aims of this study are to (1) characterize the contemporary extremity wound "bioburden" at the time of definitive wound closure; (2) determine the concordance between polymerase chain reaction results and hospital microbiology; (3) determine, among those who develop deep infections, the concordance between the pathogens at wound closure and at deep infection; and (4) compare the probability of deep infection between those who did and did not receive an appropriate course of antibiotics based on bioburden at the time of wound closure. To address these aims, sites collected tissue samples from severe lower extremity injuries at the time of wound closure and at first surgery for treatment of a deep infection, nonunion, flap failure, amputation, or other complications (because these surgeries may be due to undetected infection). Otherwise, if no further surgical treatment occurred, participants were followed for 12 months. The study was conducted at 38 US trauma centers and has enrolled 655 participants aged 18-64 years. This is the first large multi-institutional study evaluating the wound bioburden of severe open tibia fractures and correlating this bioburden with the risk of wound complications after definitive soft tissue closure.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Bacteria / isolation & purification*
  • Bacterial Infections / epidemiology
  • Bacterial Infections / microbiology*
  • Bacterial Infections / prevention & control
  • Bandages / microbiology
  • Colony Count, Microbial / statistics & numerical data*
  • Cost of Illness
  • Female
  • Humans
  • Male
  • Middle Aged
  • Statistics as Topic
  • Surgical Wound Infection / drug therapy
  • Surgical Wound Infection / epidemiology
  • Surgical Wound Infection / microbiology*
  • Tibial Fractures / epidemiology
  • Tibial Fractures / microbiology*
  • Tibial Fractures / surgery*
  • Trauma Severity Indices
  • United States / epidemiology
  • Wound Closure Techniques / statistics & numerical data*
  • Young Adult


  • Anti-Bacterial Agents