DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20212425

Evaluation of bacteriological contamination pattern of open fractures of extremities in tertiary care hospital

Sourabh Jain, Ashok Kumar, Anurag Chhabra, Krishan Kumar, Kulveer Chaudhary

Abstract


Background: Open fractures and associated complications like infection are fairly common in developing countries due to rising incidence of high velocity trauma. Primary goal of study is to evaluate the pattern of bacteriological contamination of open fractures of extremities in tertiary care hospital.

Methods: A total of 316 patients of all the age group, both the sexes with open fractures of extremities presented within 6 hours were taken in to study. 1st swab taken at the time of primary wound examination followed by 2nd culture swab on just after debridement followed by 3rd culture swab on the day of 1st aseptic dressing followed by 4th culture swab if infection continues or asepsis score is more than 20 till the duration of 4 days. Culture and sensitivity reports were collected for studying pattern of bacterial isolates and their sensitivity.

Results: Infection developed in 22.5% of the patients with open fractures of extremities in whom most of bacterial infections were caused by gram-negative organisms (80.3%). Cultures on admission were positive in 41 patients, out of which 11 patients had developed infection in the final cultures but with different flora. While cultures taken at 1st aseptic dressing were found to be positive in 51 cases, out of which 31 had developed infection with prognostic value of 57%.

Conclusions: We concluded that cultures obtained at 1st aseptic dressing are far more predictive than pre and post-debridement cultures in management of patients with open fractures of extremities and are important in formulating an antibiotic policy.


Keywords


Open fractures, Debridement, Infection, Antibiotics

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References


Lawrence RM, Hoeprich PD, Huston AC, Benson DR, Riggins RS. Quantitative microbiology of traumatic orthopedic wounds. J Clin Microbiol. 1978;8:673-5.

Anglen JO. Comparison of soap and antibiotic solutions for irrigation of lower-limb open fracture wounds. A prospective, randomized study. J Bone Joint Surg Am. 2005;87:1415-22.

Hauser CJ, Adams CA Jr., Eachempati SR. Council of the Surgical Infection Society. Surgical Infection Society guideline: Prophylactic antibiotic use in open fractures: An evidence-based guideline. Surg Infect. 2006;7:379-405.

Zalavras CG, Marcus RE, Levin LS, Patzakis MJ. Management of open fractures and subsequent complications. J Bone Joint Surg Am. 2007;89:884-5.

Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58:453-8.

Okike K, Bhattacharyya T. Trends in the management of open fractures. J Bone Joint Surg Am. 2006;88:2739-48.

Patzakis M, Harvey P Jr., Iveler D. The role of antibiotics in management of open fractures. J Bone Joint Surg Am. 1974;56:532-41.

Faisham WI, Nordin S, Aidura M. Bacteriological study and its role in the management of open tibial fracture. Med J Malaysia. 2001;56:201-6.

Agarwal D, Maheshwari R, Agrawal A, Chauhan VD, Juyal A. To study the pattern of bacterial isolates in open fractures. J Orthop Traumatol Rehabil. 2015;8:1-5.

Lingaraj R, Santoshi JA, Devi S, Najimudeen S, Gnanadoss JJ, Kanagasabai, R, et al. Predebridement wound culture in open fractures does not predict postoperative wound infection: A pilot study. J Nat Sci Biol Med. 2015;6:63-8.

Sitati FC, Mosi PO, Mwangi JC. Early Bacterial Cultures from Open Fractures - Differences before and after debridement. Ann Afr Surg. 2017;14:66-70.

Mangala A, Arthi K, Deepa R. Comparison of predebridement and debridement cultures in predicting postoperative infections in compound fractures. J Clin Diagnostic Res. 2018;12:6-9.

Bhatty S, Paul R, Kaur H. Study of microbiological flora and role of primary bacterial cultures in management of open fractures of long bones. Int J Orthop Sci. 2018;4:91-4.

Abraham Y, Wamisho BL. Microbial susceptibility of bacteria isolated from open fracture wounds. Afr J Microbiol Res. 2009;3:939-51.