Early Bacterial Cultures from Open Fractures - Differences Before and After Debridement

Abstract

Background: The pattern of organisms found in open fractures is important in the selection of antibiotics for prophylaxis and empirical treatment. So far, there is paucity of data on local patterns of bacteria contaminating and infecting open fractures and their antibiotic susceptibility profile. Objective: To describe the pattern and antibiotic susceptibility of bacterial isolates obtained within 24 hours of injury from open fractures and to compare these to bacterial isolates from fractures that subsequently develop infection. Methods:A prospective study of 98 patients with open fractures seen at Kenyatta National Hospital (KNH) within 24 hours of injury between November 2015 and March 2016 was conducted. Swabs for culture and sensitivity were taken from the wounds and antibiotics initiated.Surgical debridement was subsequently carried out witha 14 day follow up for wound infection. Wounds thatbecame infected were sampled for cultures And sensitivity. Results: Fifty-one (52.2%) pre debridement wound samples had positive cultures. Staphylococcus aureus and (Coagulase Negative) CON Staphylococci were the predominant gram positive isolates. At 14 days' follow-up, the infection rate was58.9 %. The predominant gram positive isolate was Staphylococcus aureus. Only 5.7% of the predebridement isolates were similar to the post debridement isolates. Conclusions: The contaminating organisms are not similar to the organisms isolated from injuries that later develop infection.

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

“…9 In our study, most of bacterial infections in open fracture wounds were caused by gram-negative organisms (80.3%) with Pseudomonas and Klebsiella were the most predominant gram negative isolates. These findings are consistent with those found by Sitati et al 11 In the present study, Staphylococcus aureus was found to be predominant gram-positive isolates. Mangala et al and Bhatty et al noticed the same thing.…”

“…However, these drugs are costly and not to be recommended for prophylaxis to protect their efficacy. In our study, grampositive organisms also showed high susceptibility to 3 rd generation cephalosporins (cefotaxime 78.8%) and these findings are consistent with those found by Sitati et al 11 In the present study, amikacin and ciprofloxacin were found to be the most effective antibiotics against the tested gram-negative organisms except Citrobacter and these findings are consistent with those found by Sitati et al and Agarwal et al 9,11…”

A prospective study of bacterial isolates profile in infected open fractures

“…Local studies at our hospital by Ondari et al (2016) and Sitati et al (2017) showed a higher overall proportion of gram positive than gram negative isolates, with S. aureus being the most predominant. Our results were different from these two studies.…”

“…Further contamination occurs in the course of management at the hospital. A study done to determine if organisms isolated from wounds before initial debridement are similar to those causing infection after debridement found that the isolates were not similar and that infections were mainly caused by nosocomial microorganisms (Sitati et al, 2017). The profile of microbial isolates in infected open fractures may vary from one health institution to another and from time to time.…”

12 pasos para reducir la incidencia de carbapenemasas

“…La toma de cultivos antes de la limpieza quirúrgica puede resultar en el tratamiento antibiótico innecesario. Dos estudios recientes han demostrado que los cultivos tomados superficialmente no predicen la infección de la herida en el período posoperatorio, ya que los microrganismos aislados en ellos difieren de aquellos obtenidos de la herida una vez que la misma presenta signos de infección (47,48).…”