Bacterial infection of fasciotomy wounds following decompression for acute compartment syndrome

Abstract

Objective: Acute Compartment Syndrome (ACS) is a serious complication generally requiring treatment with an emergency decompressive fasciotomy. The aim of this study was to identify the most prevalent organisms involved in fasciotomy wound infections, and to determine the best strategies to mitigate this risk.

Design: Retrospective review.

Setting: Single tertiary referral centre.

Patients/participants: Patients (n = 370) who underwent fasciotomy for emergency ACS were included in this study. Positive wound swabs and tissue samples within 30 days post fasciotomy were identified, and extended antibiotic sensitivities were recorded. Patient medical charts were reviewed to assess infection rate, causative organism(s), and clinical outcomes.

Intervention: Fasciotomy Main Outcome Measurements: Most prevalent organism in fasciotomy wound infections, and the rate of any associated morbidity and mortality.

Results: The overall infection rate was 16.7%. Infection rates were significantly higher in burns (27%) and trauma (22%) patients than vascular patients (13%) (p = 0.002). The most prevalent organism was Pseudomonas aeruginosa, isolated from 23% of all wound specimens and comprising over a third (35%) of infections overall. Ten patients required amputation for infection control. Six of these were secondary to Pseudomonas infection, whereby one patient mortality occurred.

Conclusion: In this series, one in six fasciotomies for ACS developed an infection within 30 days of their index procedure. Burns and trauma comprised the highest risk groups. Facultative anaerobes were the predominant organisms involved in fasciotomy wound infections. A combination of aminoglycosides and beta-lactams with quinolones should be considered when commencing empiric therapy for fasciotomy wound infections. Antibiotic coverage for routine peri‑operative prophylaxis following emergency decompression for acute compartment syndrome should be strongly considered, particularly in burns or trauma cases.

Level of evidence: Aetiologic Level III.