Incidence of Post-Operative Wound Infections and Bacterial Antibiotic Sensitivity Patterns in Compound Fractures
Incidence of Post-Operative Wound Infections and Bacterial Antibiotic Sensitivity
Keywords:
wound infection, compound fractures, and antibioticsAbstract
Objectives: To know the incidence of post-operative wound infections in compound fractures & to evaluate the bacterial isolate and to identify the antibiotic sensitivity patterns in compound fractures to facilitate the use of effective prophylactic antibiotics to prevent infections. Methodology: This was a prospective study conducted at Jawahar Lal Nehru Medical College and Hospital between 1st may 2014 to 31st July 2014.This study included all the patients with Compound fractures of extremities, presenting to Orthopaedic emergency. All the open fractures were classified according to the Gustilo and Anderson’s classification. Two pus culture swabs were taken in all patients under all aseptic precautions. First sample was taken at time of arrival of patient at emergency department, and immediately sent for culture and sensitivity. Prophylactic antibiotic (i.v. cefoperazone) was started immediately after taking the first culture. Second pus culture swab was taken after three days, at the time of wound inspection. All the fractures were managed with thorough wound debridement and fracture stabilization. Data was collected according to set proforma, regarding the results of initial and post-operative swab cultures and were analysed. Observation & Results: This study involved fourty patients with compound fractures of extremities presenting to the emergency department. The incidence of wound infection before any operative procedure i.e, first pus culture in the study was fifty five percentage.. Out of twenty two infected cases thirteen patients had staphylococcus aureus as the growing organism. All Staph.aureus were found to be sensitive to amikacin, vancomycin. The incidence of wound infection in second pus culture report was found to be thirty percentages. In the second swab culture sample which was taken on third day, eight (twenty percentage) cultures showed Staph. aureus. Six were sensitive to amikacin, six were sensitive to cefazoline. Conclusion: Compound fractures are associated with high incidence of infection. Antibiotics should be such that it covers all the commonly infecting organisms. In this study the commonest infecting organism was found to be Staph. aureus followed by E. fecalis, Citrobacter, E. coli and Klebsiella. It indicates that antibotics should be given initially empirically to cover the Gram positive and negative bacteria followed by giving specific antibiotics following pus culture report to combat and eradicate wound infection. Most of these organisms were found to be sensitive to Cephalosporins, Vancomycin and Aminoglycosides. Thus it is highly recommended that Prophylactic antibiotics in the management of compound fractures should always include one Cephalosporin or Vancomycin and one Aminoglycoside to cover the commonly infecting organisms. The results of this study may hold true for elective Orthopaedic procedures also.[Khan N NJIRM 2015; 6(1):21-26]
References
2. Carsenti-Etesse H, Doyon F, Desplaces N, Gagey O, Tancrede C, Pradier C, Dunais B, Dellamonica P. Epidemiology of bacterial infection during management of open leg fractures. Eur J Clin Microbiol Infect Dis. 1999. 18:315–23.
3. Zalavras CG, Marcus RE, Levin LS, Patzakis MJ.Management of open fractures and subsequent complications. J. Bone Joint Surg. Am .2007; 89:884-95.
4. Sen RK, Murthy NRS, Gill SS, Nagi ON. Bacterial load in tissues and its predictive value for infection in open fractures. J Orthop Surg. 2000; 8: 1-5.
5. Kem IC, Oginni LM, Bamgboye EA, Ako-Nai AK, Onipade AO. The bacteriology of open fractures in Ile-Ife, Nigeria. Niger J Med. 2004; 13: 359-65.
6. Robinson D, On E, Hadas N, Halperin N, Hofman S, Boldur. East practice management guidelines work group: practice management guidelines for prophylactic antibiotic use in open fractures.J Orthop Trauma 1989;3:283-286.
7. Tewodros W, Gedebou M. Staphylococcus aureus isolated from a surgical department. Ethiop Med J.1983; 21:209-16.
8. Belihu A, Lindtjorn B. Increasing incidence of resistance to antimicrobials in Sidamo. Ethiop Med J.1999; 37:181-7.
9. Ahmed E, Chaka T. Orthopaedic and major limb trauma at the Tikur Anbessa University Hospital, Addis Ababa – Ethiopia. ECAJS. 2006;11: 43-50.
10. Biruk WL, Wubshet K. Chronic osteomyelitis at Tikur Anbessa Hospital, Addis Ababa University, Ethiopia. ECAJS. 2007; 12:33-41.
11. Woldetenssaie Z. Staphylococci: Frequency of isolation and antibiotic susceptibility patterns in Jimma Hospital, South West Ethiopia. Ethiop Med J. 2000; 38:175-84. 12. Ali MH, Hoekzema NA, Bakleh M, Shin AY, Osmon DR. The microbiology and risk of infection following open, agricultural upper extremity injuries. J Hand Surg Am. 2008 Jan; 33(1):87-93.
13. Kindsfater k, Jonassen et al.Osteomyelitis in compound grade 2 and 3 open tibia fracture with late debridement.journal orthop. Trauma.1995; 9:121-127.
