{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:50:20Z","timestamp":1787755820519,"version":"build-2784847793"},"reference-count":8,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,6,18]]},"abstract":"\n Background:<\/jats:title>\n The purpose of this study was to describe the culture and speciation results of patients with surgical site infection (SSI) from the PREPARE and Aqueous-PREP studies from the PREP-IT Investigators.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Patients with suspected SSI underwent collection of deep or organ tissue samples for culture. The culture positivity rate was estimated as a percentage along with the exact binomial 95% confidence interval (CI). Microbial species were reported as percentages. Comparisons between open and closed fractures were conducted with the Z-test for proportions. Significance was set at p < 0.05.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Among the 2 primary studies, a total of 484 cases (defined as an anatomic fracture area; some patients had multiple fractures, which were each defined as a case if they developed an infection) had culture samples taken from deep or organ tissue. The culture positivity rate was 96.7% (95% CI, 94.7% to 98.0% [468 of 484 cases]). There were no significant differences (p = 0.507) in culture positivity between open fractures (97.2% [95% CI, 94.5% to 98.6%]; 273 of 281 cases) and closed fractures (96.1% [95% CI, 92.4% to 98.0%]; 195 of 203 cases). There was information on microbial species in 84.4% (395) of 468 cases. For patients with positive cultures, 43.3% (171 of 395 cases) were polymicrobial infections. Open fractures (47.8% [111 of 232 cases]), compared with closed fractures (36.8% [60 of 163 cases]), were more likely to be polymicrobial (p = 0.029).\n Staphylococcus aureus<\/jats:italic>\n microbes (methicillin-sensitive\n S. aureus<\/jats:italic>\n , methicillin-resistant\n S. aureus<\/jats:italic>\n , and coagulase-negative\n S. aureus<\/jats:italic>\n ) accounted for 43.3% (462 of 1,066) of all positive cultures. The median time to infection was 58.5 days (95% CI, 49.0 to 67.0 days). The median time to infection was not significantly different in cases of open fractures (61.0 days [95% CI, 51.0 to 71.0 days]) compared with closed fractures (54.0 days [95% CI, 43.0 to 67.0 days]) (hazard ratio [HR], 0.92 [95% CI, 0.72 to 1.12]). SSIs associated with gram-negative bacteria had a shorter median time to infection at 46.0 days (95% CI, 36.0 to 58.0 days) compared with SSIs not associated with gram-negative bacteria at 70.0 days (95% CI, 56.0 to 88.0 days) (HR, 1.79 [95% CI, 1.55 to 2.03]). There was also a shorter median time to infection for patients with polymicrobial infections (47.0 days [95% CI, 38.8 to 52.1 days]) compared with patients with monomicrobial infections (78.6 days [95% CI, 57.2 to 86.8 days]) (HR, 1.26 [95% CI, 1.03 to 1.49]).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n In patients with SSI, tissue samples yielded high rates of microbial culture results. There was a higher proportion of gram-negative organisms in open fractures. Gram-negative infections were also associated with earlier time to infection. Clinicians should not hesitate to take deep-tissue culture samples in patients with suspected SSI and should be prepared to encounter polymicrobial infections.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Diagnostic\n Level III<\/jats:underline>\n . See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.24.01249","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T11:00:30Z","timestamp":1750244430000},"page":"71-79","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Deep Infections After Open and Closed Fractures"],"prefix":"10.2106","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6986-8436","authenticated-orcid":false,"given":"Michael","family":"Polmear","sequence":"first","affiliation":[{"name":"University of Florida, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9023-262X","authenticated-orcid":false,"given":"Jennifer E.","family":"Hagen","sequence":"additional","affiliation":[{"name":"University of Florida, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3013-139X","authenticated-orcid":false,"given":"Gregory M.","family":"Schrank","sequence":"additional","affiliation":[{"name":"University of Maryland, College Park, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4047-6818","authenticated-orcid":false,"given":"Marilyn","family":"Heng","sequence":"additional","affiliation":[{"name":"University of Miami Leonard M. Miller School of Medicine, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesc A.","family":"Marcano-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Universitat Aut\u00f2noma de Barcelona, Bellaterra, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3603-3344","authenticated-orcid":false,"given":"Kyle J.","family":"Jeray","sequence":"additional","affiliation":[{"name":"Prisma Health Greenville Memorial Hospital, Greenville, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7410-7850","authenticated-orcid":false,"given":"Mark J.","family":"Gage","sequence":"additional","affiliation":[{"name":"University of Maryland, College Park, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9111-9239","authenticated-orcid":false,"given":"Gerard P.","family":"Slobogean","sequence":"additional","affiliation":[{"name":"University of Maryland, College Park, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1466-8063","authenticated-orcid":false,"given":"Sheila","family":"Sprague","sequence":"additional","affiliation":[{"name":"McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8066-2703","authenticated-orcid":false,"given":"Terrie","family":"Vasilopoulos","sequence":"additional","affiliation":[{"name":"University of Florida, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the PREP-IT Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,6,18]]},"reference":[{"issue":"10360","key":"bib1-20250619","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1016\/S0140-6736(22)01652-X","article-title":"Aqueous skin antisepsis before surgical fixation of open fractures (Aqueous-PREP): a multiple-period, cluster-randomised, crossover trial","volume":"400","year":"2022","journal-title":"Lancet."},{"issue":"5","key":"bib2-20250619","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1056\/NEJMoa2307679","article-title":"Skin antisepsis before surgical fixation of extremity fractures","volume":"390","author":"Sprague","year":"2024","journal-title":"N Engl J Med."},{"issue":"10","key":"bib4-20250619","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1093\/asj\/sjz089","article-title":"Surgical site infections in aesthetic surgery","volume":"39","author":"Kaoutzanis","year":"2019","journal-title":"Aesthet Surg J."},{"issue":"3","key":"bib5-20250619","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.jspd.2018.09.011","article-title":"Risk factors for early infection in pediatric spinal deformity surgery: a multivariate analysis","volume":"7","author":"Du","year":"2019","journal-title":"Spine Deform."},{"issue":"10","key":"bib6-20250619","doi-asserted-by":"crossref","first-page":"858","DOI":"10.2106\/JBJS.23.00157","article-title":"The bioburden associated with severe open tibial fracture wounds at the time of definitive closure or coverage: the BIOBURDEN study","volume":"106","year":"2024","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"bib7-20250619","doi-asserted-by":"crossref","first-page":"231","DOI":"10.52312\/jdrs.2023.1437","article-title":"Outcomes of culture-negative or -positive periprosthetic joint infections: a systematic review and meta-analysis","volume":"35","author":"Lai","year":"2024","journal-title":"Jt Dis Relat Surg."},{"issue":"3","key":"bib8-20250619","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.injury.2017.08.040","article-title":"Fracture-related infection: a consensus on definition from an international expert group","volume":"49","author":"Metsemakers","year":"2018","journal-title":"Injury."},{"issue":"5","key":"bib10-20250619","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1097\/BOT.0000000000002782","article-title":"Mismatch rate of empirical antimicrobial treatment in fracture-related infections","volume":"38","author":"Jacobs","year":"2024","journal-title":"J Orthop Trauma."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.01249","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:51:00Z","timestamp":1787752260000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.01249"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,18]]},"references-count":8,"journal-issue":{"issue":"Suppl 1","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.24.01249","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,18]]}}}