Table of Contents    
CASE SERIES
 
Multi drug resistant pseudomonas infection in open fractures post definitive fixation leading to limb loss: A report of three cases
Hitendra K Dosh1, Kenon Chua2, Fareed Kagda3, Paul Ananth Tambyah4
1Associate Consultant Surgeon, Department of Orthopaedics, National University Hospital of Singapore, Singapore.
2Medical Officer, Department of Orthopaedics, National University Hospital of Singapore, Singapore.
3Senior Consultant, Department of Orthopaedics, National University Hospital of Singapore, Singapore.
4Senior Consultant, Department of Orthopaedics, National University Hospital of Singapore, Singapore.

doi:10.5348/ijcri-2011-05-31-CS-1

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How to cite this article:
Doshi HK, Chua K, Kagda F, Tambyah PA. Multi drug resistant pseudomonas infection in open fractures post definitive fixation leading to limb loss: A report of three cases. International Journal of Case Reports and Images 2011;2(5):1-6.


Abstract
Introduction: Infection is a common complication in multiply traumatized patients with the majority being nosocomial in origin. We report a series of three patients with open fractures of lower limb which were initially debrided and stabilized with external fixation. Subsequent conversion to definitive internal fixation was performed. All three patients subsequently suffered limb loss as a result of multiple drug resistant pseudomonas aeroginosa infection.
Case Series: We report three cases. Case 1 is a 48-year-old alcoholic male who sustained a Gustilo grade 3 (a) open fracture of the right tibia and Gustilo grade 1 open fracture on the contralateral tibia. He underwent definitive fixation but subsequently developed a multiple drug resistant pseudomonas aeroginosa infection of the wound. Failure to eradicate the infection and deteriorating soft tissue conditions with infected non-union lead to a final outcome of below knee amputation and secondary stump closure. Case 2 is a 62-year-old male with no significant medical history who sustained a right grade 3 (a) supracondylar femur fracture and a left grade 3 (c) supracondylar femur fracture. He underwent definitive fixation after negative culture results but later developed multiple drug resistant pseudomonas aeroginosa wound infection. Failure to eradicate the infection, bony destruction and deteriorating soft tissue conditions led to a final outcome of removal of implant and above knee amputation post trauma. Case 3 is a 32-year-old female with no significant medical history who sustained a right gustilo 3 (a) supracondylar femur fracture. She later underwent definitive fixation after negative cultures. She subsequently had a multiple drug resistant pseudomonas aeroginosa wound infection. Failure to eradicate the infection and deteriorating soft tissue conditions with progressive destruction of bone led to a final outcome of above knee amputation.
Conclusion: Multiple drug resistant pseudomonas wound infection is a very serious complication for patients with high energy open fractures; with a high likelihood of limb loss. Hospital measures to prevent the spread of nosocomial infection is critical for such patients.

Key Words: Open fracture, Internal fixation, Drug resistant pseudomonas, Amputation

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Author Contributions:
Hitendra Doshi - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, final approval of the version to be published
Kenon Chua - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Fareed Kagda - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Paul Ananth Thambyah - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission:
The corresponding author is the guarantor of submission.
Source of support:
None
Conflict of interest:
Authors declare no conflict of interest.
Copyright:
© Hitendra K Doshi et. al. 2011; This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.)