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

Abstract

Background: Fracture Related Infection (FRI) in closed trauma here is considered as any deep or organ/space surgical site infection and/or osteomyelitis which occurs following an internal fixation of a closed fracture. FRI in closed trauma is a serious and invalidating illness characterised by a high rate of treatment failures and often requires long periods of treatment and hospital admission, leading to temporary impairment and at times long lasting disability or even permanent handicaps. The present study was realised to determine the epidemiological and susceptibility profile of bacterial isolates of FRI in closed trauma in our milieu.Method: A prospective cohort study was carried out from November 2020 to May 2021 in four reference hospitals of Yaoundé. All patients diagnosed with FRI in closed trauma amongst fractured cases treated by internal fixation were recruited, socio-clinical information was taken, and clinical specimens were collected and cultured in routine culture media. The organisms isolated were identified by routine standard procedures. Antimicrobial susceptibility testing was done by Kirby-Bauer's disc diffusion method and the results interpreted using guidelines of the « comité de l'antibiogramme de la société française de microbiologie (CASFM) » Results: Out of the 120 patients followed up, 19 (15.83%) developed infection. The modal age was 20-40 (57.9%). The commonest bones infected were the femur (42.11%), and tibia (36.84%). Highest osteosynthesis involved were plate and screw (73.3%) and reamed intramedullary nailing (26.8%). Predisposing factors were long time lapse between trauma and surgery and scarification. Out of 19 samples, 17 yielded positive culture giving rise to 6 bacteria isolates. Thirteen samples (76.5%) were monobacterial while four (23.5%) were polybacterial. The most predominant species was Staphylococcus aureus (52.4%), followed by Enterobacter cloacae (19.0%), Escherichia coli (9.5%), and Klebsiella pneumonia (9.5%). The Gram-positive organisms showed good sensitivity to Vancomycine (81.8%), Clindamycine (72.7%), Gentamycine, Rifampicine and Fusidic acid (63.6%) and to a lesser extend Nitroflurantoine and Nitilmycine (54.5%). Conclusion:The bacteria flora of FRI in closed trauma is dominated by nosocomial germs, which are developing resistances to most frequently prescribed antibiotics in our setting, thus emphasizing on hygiene and targeted antibiotherapy.