Clinical and microbiological profile of post-traumatic osteomyelitis in tertiary hospital in Yaoundé –Cameroon

Abstract

Background: Post-traumatic osteomyelitis is bone infection secondary to a trauma (open fracture or bone surgery). It is a painful and frustrating disease characterised by a high rates of therapeutic failures and a costly management. However, treatment is increasingly becoming difficult because of the phenomenon of antibiotic resistance. The present study was realised to determine the epidemiological and susceptibility profile of bacterial isolates in posttraumatic osteomyelitis in a tertiary hospital in the city of Yaoundé. Method: A descriptive cross-sectional study was carried out between November 2016 and May 2017. Patients admitted for post-traumatic osteomyelitis were recruited. After recoding clinical informations, deep specimens were taken during surgical debridement and were cultured in Blood, Mannitol Salt and MacConkey plates at 37 o C for 24-72hrs. Culture isolates were identified by standard biochemical reactions. Antibiotic susceptibility was performed by Kirby-Bauer method using the CASFM guidelines. Results: A total of 31 patients were recruited; the modal age range was 21-50 years (67.8%) and the sex ratio 1.8:4. The commonest bones affected were the tibia (48.5%) and femur (32.3%). Predisposing factors identified included open fractures (76%), delay surgical debridement (83.3%), presence of prosthesis (58%) and surgical wound infections (23%). Out of 31 samples, 29 yielded positive culture giving rise to 48 bacteria isolates. Fourteen samples (48%) were polybacterial. The most predominant species was Escherichia coli (29%), followed by Staphylococcus aureus, Pseudomonas aeruginosa and Klebsiella pneumoniae (all 22.6%). The Gram positive organisms showed good sensitivity to Imipenem, Rifampicin, Fucidine, Lincomycin, and to Vancomycin whereas the Gram negative bacilli were mostly sensitive to Imipenem (96.7%), Amikacin (82.1%) and to a lesser extend Quinolones (54%) and Piperacillin/Tazobactam and Ceftazidime (48%). Conclusion: Nosocomial bacteria dominate the bacterial flora of posttraumatic osteomyelitis in our setting and many multidrug resistant strains are emerging thus emphasizing on the importance of hygiene and targeted antibiotherapy.

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“…The femur was the highest bone involved in infections accounting for 8 cases (42.11%). These results do not correlate with those obtained from studies conducted in Cameroon in 2005 and 2017 [3,4] in which the tibia was reported as the highest bone involved in osteomyelitis (34.8%) and post-traumatic osteomyelitis (48.4%). Another study conducted in Mali in 2008 [5] reported the tibia as the most frequent (38.03%) bone in lower limb osteomyelitis followed by the femur (35.21%).…”

Fracture Related Infections in Closed Trauma; Current Clinical and Microbiological Profile

“…As a result, patients with FRI in closed trauma have high morbidity rates and are less likely to return to duty. The increasingly frequent use of internal fixation and the emergence of antibiotic resistant microorganisms have exacerbated this problem [3].…”