{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T14:58:03Z","timestamp":1780066683633,"version":"3.54.0"},"reference-count":31,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2023,3,15]],"date-time":"2023-03-15T00:00:00Z","timestamp":1678838400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot Ankle Int."],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Infection is one of the challenging complications after open reduction and internal fixation for ankle fractures. Previously published case series conclude that Staphylococcus aureus is the most frequent causative microorganism. An unexpected increase in Enterobacter cloacae infections after this surgery was observed in a preliminary analysis of data at the promoting center of the study. In traumatology, its incidence has been reported in chronic osteomyelitis, prosthetic infections, septic osteoarthritis, open fractures in children and adults, and fractures other than the ankle. Because of this unexpected finding, we decided to perform this study to analyze the demographic and microbiological variables of acute osteosynthesis infection after ankle fracture and determine the distinctive features of the patients with E cloacae infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We performed a retrospective multicenter study including 4 university hospitals. All patients diagnosed with acute osteosynthesis infection after ankle fracture fixation between January 2015 and December 2018 were included. We analyzed demographic data, type of fracture, surgical technique, and microorganisms responsible for the infection. We performed a descriptive statistical analysis of the variables. Univariate and multivariate regression analysis were performed to compare patients with E cloacae infection to patients with infection caused by other microorganisms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 65 patients were included. A predominance of polymicrobial infections (24.62%), followed by infections caused by S aureus (23.07%) and E cloacae (23.07%) was observed. When E cloacae isolated in polymicrobial infections were added, the incidence of E cloacae as a causative microorganism increased to 32.3%. Patients with E cloacae infection were older (64\/53, P\u2009=\u2009.008) and had a higher requirement of negative-pressure therapy after surgical debridement (71%\/40%, P\u2009=\u2009.017).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>A high incidence of E cloacae infections was observed. Patients with E cloacae infection were generally older and required a higher use of negative-pressure therapy after debridement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level V, mechanism-based reasoning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10711007231157688","type":"journal-article","created":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T02:20:15Z","timestamp":1678933215000},"page":"424-430","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["<i>Enterobacter cloacae<\/i>\n                    Infection After Surgical Treatment of Ankle Fractures, a Multicenter Observational Study"],"prefix":"10.1177","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5453-5305","authenticated-orcid":false,"given":"Carlos","family":"Garc\u00eda Cardona","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Traumatology, Hospital Universitari M\u00fatua Terrassa, Terrassa, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mart\u00ed Carles","family":"Bernaus Johnson","sequence":"additional","affiliation":[{"name":"Osteoarticular Infection Unit, Department of Orthopedics and Traumatology, Hospital Universitari M\u00fatua Terrassa, Terrassa, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Mart\u00ednez Ros","sequence":"additional","affiliation":[{"name":"Osteoarticular Infection Unit, Department of Orthopedics and Traumatology, Hospital Cl\u00ednico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nerea","family":"Hern\u00e1ndez-Gonzalez","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Hospital Universitario de Cruces, Barakaldo, Bizkaia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1lvaro","family":"Au\u00f1on Rubio","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesc","family":"Angl\u00e8s Crespo","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Hospital Universitari M\u00fatua Terrassa, Terrassa, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iraia","family":"Arteagoitia-Colino","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Hospital Universitario de Cruces, Barakaldo, Bizkaia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismael","family":"Coifman-Lucena","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Esteban-Moreno","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Encarnaci\u00f3n","family":"Moral Escudero","sequence":"additional","affiliation":[{"name":"Osteoarticular Infection Unit, Department of Infectious Medicine, Hospital Cl\u00ednico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc\u00eda","family":"G\u00f3mez Garc\u00eda","sequence":"additional","affiliation":[{"name":"Osteoarticular Infection Unit, Department of Infectious Diseases, Hospital Universitari M\u00fatua Terrassa, Terrassa, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"N\u00f3voa Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Hospital Universitario de Cruces, Barakaldo, Bizkaia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Ortega Columbrans","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Hospital Cl\u00ednico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margarita","family":"Veloso Duran","sequence":"additional","affiliation":[{"name":"Osteoarticular Infection Unit, Department of Orthopedics and Traumatology, Hospital Universitari M\u00fatua Terrassa, Terrassa, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Llu\u00eds","family":"Font-Vizcarra","sequence":"additional","affiliation":[{"name":"Osteoarticular 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