Multi drug resistant pseudomonas infection in open fractures post definitive fixation leading to limb loss: A report of three cases

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 report: 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 32year-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.