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Bacterial Identification and Visualization of Bacterial Biofilms Adjacent to Fracture Sites After Internal Fixation
Journal article   Peer reviewed

Bacterial Identification and Visualization of Bacterial Biofilms Adjacent to Fracture Sites After Internal Fixation

Michael P Palmer, Daniel T Altman, Gregory T Altman, Jeffrey J Sewecke, Courtney Saltarski, Laura Nistico, Rachael Melton-Kreft, Fen Z Hu and Garth D Ehrlich
Genetic testing and molecular biomarkers, v 26(2)
Feb 2022
PMID: 35225678

Abstract

Bacteria - genetics Biofilms Case-Control Studies Fractures, Ununited - diagnosis Fractures, Ununited - microbiology Fractures, Ununited - surgery Humans In Situ Hybridization, Fluorescence Retrospective Studies RNA, Ribosomal, 16S - genetics Treatment Outcome
The primary aims of this study were to determine if any correlation exists in cases of fracture fixation among: (1) bacterial profiles recovered from the instrumentation and adjacent tissues; (2) the type of orthopedic injury; and (3) the clinical outcome-union versus nonunion. A secondary goal was to compare culture and molecular diagnostics for identifying the bacterial species present following fracture fixation. Single-institution, prospective case-control cohort study. Single level 1 trauma center. Forty-nine bony nonunion cases undergoing revision internal fixation and 45 healed fracture controls undergoing removal of hardware. Bacterial infection was detected by standard microbial culture methods and by a pan-eubacterial domain, molecular diagnostic (MDx) assay. Confirmation of culture and MDx results was achieved with bacterial ribosomal 16S rRNA fluorescence hybridization (FISH) to visualize bacterial biofilms. MDx and microbial culture methods results were the primary study outcomes. Ninety-four percent of the nonunion cohort and 93% of the union cohort had bacteria detected by the MDx. Seventy-eight percent of the nonunion cases and 69% of the controls were culture negative, but MDx positive. Although no significant differences in bacterial composition were observed between the cases and controls, differences were observed when cases were divided by comorbidities. The MDx is more sensitive than microbial culture in detecting bacterial presence. The lack of significantly different findings with regard to bacterial profile identified between the cases and controls suggests that host factors and environmental conditions are largely responsible for determining if bony union will occur. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Collaboration types
Domestic collaboration
Web of Science research areas
Biochemistry & Molecular Biology
Genetics & Heredity
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