A prospective study of the bacteriological profile and risk factors of infection after internal fixation of close fractures of long bones

Authors

  • Munin Borgohain Department of Orthopaedics, Assam Medical College, Dibrugarh, Assam, India
  • Debasish Bora Department of Orthopaedics, Assam Medical College, Dibrugarh, Assam, India
  • Aswin Deepak Rajan Department of Orthopaedics, Assam Medical College, Dibrugarh, Assam, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20200737

Keywords:

Surgical site infection, Bateriological profile, Antibiotic sensitivity

Abstract

Background: Infection in implant related procedures is dreaded due to difficulty in getting rid of it. Disappointment to patients and surgeons, drainage of health care and patients’ resources is significant. Causes and risk factors are many related to host, environment and procedure. The bacteriological profile and antibiotic sensitivity have been changing trend with emerging resistance to many drugs.

Methods: A prospective observational study of 941 patients with operative fixation of long bone closed fractures. The details of the procedure, host characteristics were noted. Followed up in ward post operatively and after discharge to identify the cases of surgical site infection. Once identified they were evaluated with X-rays and lab parameters. Wound swabs or pus samples taken to find out the organisms and cultured to find the sensitivity.

Results: 116 patients (86 males and 30 females) developed SSI (incidence 12.42%). Plate fixation (18.20% infection rate), operative time >1 and half hours (15.73% rate), fracture femur (16.66% rate), ORIF (14.38% rate), age >60 yrs were some of the risk factors. Co-morbidities like anaemia, diabetes, liver disease, lung disease, immunosuppressive drugs, hypertension, smoking, alcoholics had significant association with SSI. Staphylococcus aureus was the most common organism. Gram positive showed highest sensitivity to linezolid, vancomycin and tetracycline. Gram negative showed highest sensitivity to colistin and tigecycline.

Conclusions: Infection rate should be less than 1% and hence risk factors encompassing preoperative, intraoperative and postoperative period are to be controlled. Probably the first study from north east india showing the burden of orthopaedic SSI.

Author Biographies

Munin Borgohain, Department of Orthopaedics, Assam Medical College, Dibrugarh, Assam, India

Professor and HOD

Department of Orthopaedics

Assam Medical College and Hospital

Debasish Bora, Department of Orthopaedics, Assam Medical College, Dibrugarh, Assam, India

Post Graduate Trainee

Department of Orthopaedics
Assam Medical college

Aswin Deepak Rajan, Department of Orthopaedics, Assam Medical College, Dibrugarh, Assam, India

Post Graduate Trainee

Department of Orthopaedics
Assam Medical college

References

Oakes JA, Wood AJJ. Infections in surgery. N Engl J. 1986;315:1129-38.

Van Kasteren ME, Mannien J, Kullberg BJ, de Boer AS, Nagelkerke NJ, Ridderhof M, et al. Quality improvement of surgical prophylaxis in Dutch hospitals: evaluation of a multi-site intervention by time series analysis. J Antimicrob Chemother. 2005;56(6):1094-102.

Stoodley P, Sauer K, Davies DG, Costerton JW. Biofilms as complex differentiated communities. Annu Rev Microbiol. 2002;56:187-209.

Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: A common cause of persistent infections. Science. 1999;284:1318-22.

Whitehouse JD, Friedman ND, Kirkland KB, Richardson WJ, Sexton DJ. The impact of surgical‑site infections following orthopedic surgery at a community hospital and a university hospital: Adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol. 2002;23:183‑9.

Horan TC, Gaynes R, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13:606-8.

Willenegger H, Roth B. Treatment tactics and late results in early infectionfollowing osteosynthesis. Unfallchirurgie. 1986;12:241-6.

Khosravi A, Ahmadi F, Salmanzade S, Dashtbozorg A, Montazeri EA, et al. Study of bacteria isolated from Orthopaedic implant infections and their antimicrobial susceptibility pattern. Res J Microbiol. 2009;4(4):158-63.

Jain BK, Banerjee M. Surgical site infections and its risk factors in orthopaedics: a prospective study in teaching hospital of central India. Int J Res Med. 2013;2(1):110-3.

Khan MS, ur Rehman S, Ali MA, Sultan B, Sultan S. Infection in orthopaedic implant surgery, its risk Factors and outcome. J Ayub Med Coll Abbottabad. 2008;20(1):23-5.

Tago IA, Asfhaq K, Gill P, Memon K, Kumar N Mahboob G. Post-operative infection in clean cases with the use of implant and their management. J Pakorthopassoc. 2007;19(2):46-56.

Dhillon KS, Kok CS. The incidence of post operative wound infection in orthopaedic surgery. Med J Malayasia. 1995;50(3):237-40.

Razavi SM, Ibrahimpoor M, Kashani AS, Jafarian A. Surgical site infections: incidence and risk factors at an Iranian teaching hospital. BMC surgery. 2005;5(1):2.

Kumar A, Rai A. Prevalence of surgical site infection in general surgery in a tertiary care centre in India. Int Surg J. 2017;4:3101-6.

Chang WT, Lee KT, Chuang SC, Wang SN, Kuo KK, Chen JS, et al. The impact of prophylactic antibiotics on postoperative infection complication in elective surgery: a prospective randomized study. Am J Surg. 2006;191(6):721-5.

Keswani S, Akhtar M, Saxena D, Deshpande G. Predictive factors of surgical site infections. Int Surg J. 2018;5:971-4.

Raf L. Staphylococcal wound infection complicating orthopaedic operations. Acta Orthop Scand. 1964;34:289-98.

Lidgren L, Lindberg L. Post-operative wound infections in clean orthopaedic surgery: Review of a 5-year material. Acta Orthop Scand. 1974;45(2):161-9.

Pergola C, Rogge A, Dodt G. Testosterone suppresses phospholipase D, causing sex differences in leukotriene biosynthesis in human monocytes. FASEB J. 2011;25:3377-87.

Rønø B, Engelholm LH, Lund LR, Hald A. Gender affects skin wound healing in plasminogen deficient mice. PLoS One. 2013;8:e59942.

Awan MS, Dhari FJ, Laghari AA, Bilal F, Khaskheli NM. Surgical Site infection in Elective Surgery. J Surg Pakistan. 2011;16(1):33-7.

Nazri MY, Halim YA. Outcome of Infection Following Internal Fixation of Closed Fractures. Med J Malaysia. 2004;59(5).

Ozkalkanli MY, Ozkalkanli DT, Katircioglu K, Savaci S. Comparison of tools for nutrition assessment and screening for predicting the development of complications in orthopedic surgery. Nutr Clin Pract. 2009;24(2):274-80.

Bohl DD, Shen MR, Mayo BC, Massel DH, Long WW, Modi KD, et al. Malnutrition Predicts Infectious and Wound Complications Following Posterior Lumbar Spinal Fusion. Spine (Phila.Pa.1976.). 2016;21:1693-9.

Grammatico-Guillon L, Baron S, Rosset P, Gaborit C, Bernard L, Rusch E, et al. Surgical Site Infection After Primary Hip and Knee Arthroplasty: A Cohort Study Using a Hospital Database. Infect. Control Hosp Epidemiol. 2015;10:1198-207.

Jain RK, Shukla R, Singh P, Kumar R. Epidemiology and risk factors for surgical site infections in patients requiring orthopedic surgery. Eur J Orthop Surg Traumatol. 2015;2:251-4.

Cavanaugh PK, Chen AF, Rasouli MR, Post ZD, Orozco FR, Ong AC. Complications and Mortality in Chronic Renal Failure Patients Undergoing Total Joint Arthroplasty: A Comparison Between Dialysis and Renal Transplant Patients. J Arthroplasty. 2016;31(2):465-72.

Shaffer WO, Cummins D, Murray J, Schulte D. Systematic literature review on the management of surgical site infections- Adopted by the American Academy of Orthopaedic Surgeons Board of Directors. 2018: 1-54.

Roles NC. Infection in total prosthetic replacement of the hip and knee joints. Proc. rog. SOC. Med. 1971;64(6):636-8.

Jamali AR, Mehboob G, Majid A, Bhatti A, Minhas S, Akhtar R, et al. Postoperative wound infections in Orthopaedic surgery. J Coll Physicians Surg Pak. 2001;11:746-9.

Iqbal MZ, Chima TA, Sabir MR. Rate of post-operative infection in clean orthopaedic cases. J Pak Orthop Assoc. 2001;13:121-4.

Ibtesam KA, Ehssan AB. Three months study of orthopaedic surgical site infections in an Egyptian University hospital. Int J Infect Control. 2010;6(1):25-7.

Patel SM, Patel MH, Patel SD, Soni ST, Kinariwala DM, Vegad MM. Surgical site infections: Incidence and risk factors in a tertiary care hospital, western India. National J Community Med. 2012;3(2):193-6.

Sawyer RG and Pruett TL. Wound infections. Surg Clin North Am. 1994;74:519-36.

Chowdhury MAM, Ferdous A. Identification of risk factors for post- surgical wound infections in elective operations: A multivariate statistical analysis. 2010;5:1.111.11.

Kumar S, Sengupta M, Hada V, Sarkar S, Bhatta R, Gupta MS. Early post-operative wound infection in patients undergoing orthopaedic surgery with implant. Int J Sci Stud. 2017;5(8):44-8.

Mousa HA. Infection following orthopaedic implants and bone surgery. East Mediterr Health J. 2001;7:738-43.

Darouiche RO, Landon GC, Patti GM, Nguyen LL, Fernau RC, McDevitt D, et al. Role of Staphylococcus aureus surface adhesions in orthopaedic device infections. J Med Microbiol. 1997;46:75-9.

Tunney MM, Ramage G, Patrick S, Nixon JR, Murphy PG, Gorman SP. Antimicrobial susceptibility of bacteria isolated from orthopaedic implants following revision hip surgery. Antimicrob Agents Chemother. 1998;42(11):3002-5.

Thool VU, Bhoosreddy GL, Wadher BJ. Detection of resistance to linezolid in staphylococcus aureus infecting orthopedic patients. Indian J Pathol Microbiol. 2012;55:361-4.

Raahave D. Penicillin concentrations in abdominal operation wounds after intravenous administration. Scand J Gastroenterol. 1975;10(5):551-5.

Bubbar VK. The Intention-to-Treat Principle: A Primer for the Orthopaedic Surgeon. J Bone Joint Surg (Am). 2006;88(9):2097.

Downloads

Published

2020-02-25

Issue

Section

Original Research Articles