Evaluation of Bacteriological Contamination Pattern of Open Fractures of Extremities- A Study from Tertiary Centre at Western India

Abstract

Background and Aim: In underdeveloped countries, open fractures are fairly prevalent. Open fractures can be caused by a variety of factors, including a car accident, a fall from a great height, a gunshot, an attack, machine injuries, and others. Infection is a typical side effect of open fractures. The goal of our study was to describe the pattern of bacterial contamination, antibiotic susceptibility, and possible antibiotic resistance in open fractures that arrived at our institute within 6 hours after injury. Material and Methods: A one-year prospective study was undertaken on 200 patients with open fractures of the extremities admitted to the accident and emergency department of Tertiary Care Teaching Institute of India. The first swab is obtained at the primary wound assessment, followed by the second culture swab shortly after debridement, the third culture swab on the day of the first aseptic dressing, and the fourth culture swab if the infection persists or the asepsis score is greater than 20 for a period of four days. Reports on culture and sensitivity were collected in order to analyse the pattern of bacterial isolates and their sensitivity. Results: The majority of the patients in this study were men (83%). We discovered 144 (72%) open fractures in the lower limb, with the tibia being the most often fractured bone, with 76 (38%) occurrences with right sided predominance (58%). Out of 200 patients, 78 (39%) had Gustilo II open fractures, followed by type IIIA (33%). Pre-debridement swabs were collected from all 200 patients with open fractures of the extremities upon admission. 26 (13%) of the patients were determined to be culture positive. Conclusion: In the therapy of patients with open fractures of the extremities, cultures acquired during the first aseptic dressing are considerably more predictive than pre- and post-debridement cultures, and are important in developing an antibiotic policy. It is thus recommended that cultures acquired during the first aseptic dressing provide direction in the selection of antimicrobial therapy, which, when paired with complete wound debridement, will allow for early wound closure and fewer problems.