Epidemiology, determinants, and microbiological profile of implant-associated infections following intramedullary nailing in a tertiary hospital in Ethiopia

BACKGROUND: Implant-associated infections after intramedullary nailing (IMN) are a major cause of morbidity in patients with long bone fractures. This study aimed to determine the magnitude, determinants, and microbiological profile of such infections in a tertiary hospital in Ethiopia. METHODS: A hospital-based cross-sectional study was conducted among 260 patients who underwent IMN for lower extremity long bone fractures between January 2021 and December 2023. Clinical data, operative details, and microbiological results were collected, and logistic regression was applied to identify determinants of infection. RESULTS: The overall infection rate was 8.46% (95% CI: 5.38-12.53; 22/260), comprising 4.62% deep and 3.85% superficial infections. We found that emergency surgery and hospital stay longer than 14 days were independently associated with an increased risk of infection. Among the limited number of culture-positive infections, Gram-negative bacteria predominated, with Escherichia coli as the most frequently identified pathogen. CONCLUSION: The infection rate was higher than in many other settings, underscoring the need for improved perioperative infection prevention and reduced hospital stays. Findings highlight the importance of perioperative optimization and hospital infection control in LMICs.