A study to evaluate the pattern of microorganisms causing early post-operative wound infection in patients undergoing orthopaedic surgery with implant for closed fracture or disease in medical college and hospital, Kolkata
Keywords:Surgical site infections, Post-operative wound infection, Orthopaedic surgery, Implants, Microorganisms
Background: For all orthopaedic surgical procedures with implant, infection at the operative site has always been recognized as a potential complication. The present study was done to evaluate the pattern of causative microorganisms in post-operative infection after orthopaedic surgery with implant in Medical College and Hospital, Kolkata.
Methods: This study was Institution based cross-sectional observational case study. Patients population were selected from the patients, who were admitted or came for follow up in the Department of Orthopaedics, who had undergone surgery with implant for close fracture and disease and developed early (<3 months) post-operative wound infection The samples were collected and were sent to the Department of Microbiology, Medical College & Hospital, Kolkata for isolation and identification of the microorganisms and their antimicrobial susceptibility were done.
Results: Maximum infections were detected and wound swabs were sent for culture in 2nd week of surgery followed by 3rd week. Only 10% (8 cases) had infection beyond 8 weeks. Plates with screws were used in 37 cases (46%) and nails in 15 cases (19%). It was been seen that infection in case of hip prosthesis were significant that is 8% (6 cases) which included four cases of hemiarthroplasty and two cases of total hip arthroplasty.
Conclusions: The data suggests that there is preponderance of Gram- negative infections in operated orthopaedic patients, but Staphylococcus aureus predominates the infectious agents as the sole pathogen. Klebsiella species and pseudomonas species are second and third most common pathogens respectively.
Edwards C, Counsell C, Boulton C, Moran G. Early infection after hip fracture surgery, risk factors, costs and outcome. J Bone joint Surg. 2008;90:770-7.
Schatzker J. Principles of stable internal fixation. In: Schatzker J, Tile M (eds) The rationale of operative fracture Care. Spinger-Verlag, Berlin; 1996: 10-11.
Sisk DT. General principles of fracture treatment. In: Crenshaw AH (ed) Campbell’s operative orthopaedics. Mosby, Missouri. 1987: 1551-61.
Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004;351:1645-54.
Husebye EE, Lyberg T, Opdahl H, Aspelin T, Støen RO, Madsen JE et al. Intramedullary nailing of femoral shaft fractures in polytraumatized patients- a longitudinal, prospective and observational study of the procedure-related impact on cardiopulmonary and inflammatory responses. Scand J Trauma Resusc Emerg Med. 2012;20:2.
Trampuz A, Zimmerli W. Diagnosis and treatment of infections associated with fracture fixation devices. Injury. 2006;37(2):S59-66.
Esterhai J, Gelb I. Orthopaedic infection. Ortho. Clin. North Am. 1991;22:503-10.
Moussa FW, Anglen JO, Gehrke JC, Christensen G, Simpsonet WA. The significance of positive cultures from orthopedic fixation devices in the absence of clinical infection. Am J Orthop. 1997;26(9):617-20.
Greene LR, Mills R, Moss R, Sposato K, Vignari M. An APIC guide. Guide to the elimination of orthopaedic surgical site infections. Washington, DC: APIC; 2010. Available at: http://www.apic.org/ Resource_/EliminationGuideForm/34e03612-d1e6-4214-a76b-e532c6fc3898/File/APIC-Ortho-Guide.pdf. Accessed 22 April 2020.
Berard F, Gandon J. Post-operative wound infection: the influence of ultraviolet irradiation on the operating room and of various other factors. Ann Surg. 1964;160(2):1-192.
Zimmerli W, Lew PD, Waldvogel FA. Pathogenesis of foreign body infection. Evidence for a local granulocyte defect. J Clin Invest 1984;73:1191-1200.
Zimmerli W, Waldvogel FA, Vaudaux P, Nydegger UE. Pathogenesis of foreign body infection: description and characteristics of an animal model. J Infect Dis. 1982;146:487-97.
Montanaro L, Speziale P, Campoccia D, Ravaioli S, Cangini I, Pietrocola G, et al. Scenery of Staphylococcus implant infections in orthopedics. Future Microbiol. 2011;6:1329-49.
Nichols RL. Current Strategies for Prevention of Surgical Site infections. Curr Infect Dis Rep. 2004;6(6):426-34.
Gómez J, Rodríguez M, Baños V, Martinez L, Claver A, Ruiz J, et al. Infección de implantes osteoarticulares: factores pronósticos e influencia del tratamiento antibiótico prolongado en su evolución. Estudio prospectivo, 1992-1999 [Orthopedic implant infection: prognostic factors and influence of long-term antibiotic treatment on evolution. Prospective study, 1992-1999]. Enferm Infecc Microbiol Clin. 2003;21(5):232-6.
Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004;351(16):1645-54.
Olson M, O’Connor M, Schwartz Ml. Surgical wound infection: a five-year prospective study of 20,193 wounds at Minneapolis V.A. Medical Centre. Ann Surg. 1984;199:253-9.
Mbamali EI. Internal fixation of femoral shaft fractures at the Ahmadu Bello University Teaching Hospital Zaria. Nigerian Medical Practitioner. 1981;2:81-5.
Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP. The timing of prophylactic administration of antibiotics and the risk of surgical wound infection. N Engl J Med. 1992;326:281-5.
Efem SEE, Aja A, Inyang U. Surgical wound infection rate in Calabar University Teaching Hospital, Calabar. West Afr J Med. 1986;5:61-8.
Ojiegbe GC, Njoku-obi AN, Ojukwu J.O. Incidence and parametric determinants of post- operative wound infections in a University Teaching Hospital. Cent Afr J Med. 1990;36:63-7.
Cruse PJE, Ford R. The epidemiology of wound infection: a ten-year prospective study of 62, 939 wounds. Surg Clin Nor Am (Symposium on Surgical infection). 1980;60:20-40.
Moylan AJ, Kennedy VB. The importance of gown and drape barriers in the prevention of wound infection. Surg Gynecol Obstet. 1980;151:465-70.
Meakins JL. Guidelines for prevention of surgical site infection. In: Meakins JL (ed) Surgical infections: diagnosis and treatment. Scientific American Inc., New York. 1994;127-34.
Arciola CR, An YH, Campoccia D, Donati ME, Montanaro L. Etiology of implant orthopedic infections: A survey on 1027 clinical isolates. Int. J. Artif. Organs. 2005;28:1091-1100.
Mousa HA. Infection following orthopaedic implants and bone surgery. East Mediterr Health J. 2001;7:738-43.
Benabdeslam A, Berrady MA, Khermaz M, Mahfoud M, Berrada MS, Elyaacoubi M. Bacteriological profile of surgical site infection in orthopedic surgery about 142 cases. Int J Sci Technol Res. 2014;3:271-7.
Onche II. Postoperative wound infection in implant surgery. Dissertation submitted to the National postgraduate Medical College of Nigeria. 2000:34-43.
Oguachuba HN. Wound infection in the orthopaedic-traumatology department of Jos University Teaching Hospital, Jos, Nigeria. Nigerian Med J. 1987;17:147-51.
Agrawal AC, Jain S, Jain RK, Raza HK. Pathogenic bacteria in an orthopaedic hospital in India. J Infect Dev Ctries. 2008;2:120-3.