Microbiological profile of pre-debridement, post-debridement, and surgical wound infection on open fracture in orthopedic patients at soebandi general hospital
Keywords:Open fractures, Pre-debridement, Post-debridement, Surgical site infection
Open fractures are fairly common in developing countries. Infection is a common complication of open fractures. Pre-debridement, post-debridement, and surgical site infection (SSI) cultures are important to identify microbiological profiles to prevent infection.
We report microbiological profile of pre-debridement, post-debridement, and surgical site infection on open fracture in orthopedic patients at Soebandi General Hospital. 30 patients were taken into the study of all ages. Primarily, wound was examined and a description of the wound was recorded at 1st culture swab taken at the time of examination before debriment, followed by 2nd culture swab on 1st dressing after debridement, and 3rd culture swab if an infection continued further. Culture reports were collected for studying the pattern of bacterial isolate.
In this study, 30 patients became the study samples. The results of pre-debridement from 15 patients who had positive culture, 9 patients (56.25%) showed growth of Klebsiella sp., 3 patients (18.75%) showed growth of Proteus sp., 2 patients (12.50%) showed growth of Salmonella thypi, 1 patient (6.25%) showed growth of Shigella sonnei, and 1 patient (6.25%) showed growth of Staphylococcus aureus, and one patient culture grew several organisms. In post-debridement culture in the operating room, the results of culture identification from 12 patients showed that 5 patients (41.67%) had Klebsiella sp., 3 patients (25.00%) had Shigella sonnei, 2 patients (16.67) had Pseudomonas aeruginosa, 1 patient (8.33%) had Salmonella thypi, 1 patient (8.33%) had Proteus sp. Nine patients (30%) developed surgical wound infection with 6 patients (85.71%) showed growth of Staphylococcus aureus, 1 patient (14.29%) showed growth of Salmonella thypi, and 2 others did not show any growth of microorganism.
Microbiological profile of pre-debridement, post-debridement, and surgical wound infection cultures of open fracture were different.
World Health Organization [Internet]. Global Health Observatory Data Repository. c2011[cited 2019 month date]. Available from: http://apps.who.int/gho/data/?theme=main
Emergency Department dr. Soebandi General Hospital. Data Open Fracture 2017-2018. dr. Soebandi General Hospital 2018
Koval K.J. and Zuckerman J.D. Handbook of Fractures, 3rd Ed. Lippincott: Williams & Wilkins, 2006. pp: 20-9.
Gustilo R. B, Anderson J. T. Prevention of Infection in The Treatment of One Thousand Twenty Five Open Fractures of Long Bones: Retrospective and Prospective Analyses. The Journal of Bone & Joint Surgery—American. 1976; 58(4), 453-8.
Ercole FF, Chianca TC, Duarte D, Starling CE, Carneiro M. Surgical site infection in patients submitted to orthopedic surgery: the NNIS risk index and risk prediction. Rev Lat Am Enfermagem. 2011;19:269–76.
Center for Disease Control and Prevention (CDC). 2018. Procedure-associated Module. Surgical Site Infection (SSI) Overview.
Agarwal D, Maheshwari R, Agrawal A, Chauhan VD, Juyal A. To study the pattern of bacterial siolates in open fractures. J Orthop Traumatol Rehabil. 2015;8:1-5.
Sitati FC, Mosi PO, Mwangi JC. Early Bacterial Cultures from Open Fractures – Differences Before and After Debridement. The Annals of African Surgery. 2017;14(2).
Gupta S. et al. A Comparative Study of Efficacy of Pre and Post Debridement Culture in Open Fracture. The Internet Journal of Orthopedic Surgery. 2018; 19(3).
Sop JL, Sop A. Open Fracture Management [Updated 2019 Jan 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2019 Jan-.
Kale AR, Sonawane CS, Waghmare VU, Kalambe H. Open Fractures and Incidence of Infection in Tertiary Care Government Hospital. Inj J Sci Stud. 2017;5(5):24-8.
Guerra MTE, Gregio FM, Castro CC. Infection rate in adult patiens with open fractures treated at the emergency hospital and at the ULBRA university hospital in Canoas, Rio Grande do Sul, Brazil. Rev Bras Ortop. 2017;52(5): 544-8.
Asia Pacific Society Of Infection Control. The APSIC Guidelines For The Prevention Of Surgical Site Infection. Forthcoming 2018.
Cross WW, Swiontkowski MF. Treatment principles in the management of open fractures. Indian J Orthop. 2008;42(4):377-86
Zalavraz CG, Marcus RE, Levin LS, Patzakis MJ. Management of Open Fractures and Subsequent Complications. J Bone Joint Surg Am. 2007; 89:883-95
Deviandri R, Ismiarto YD, Singh A. Dilution of Open Fracture Grade IIIA of the Lower Leg Using Normal Saline 0,9% Mixed with Honey Compared With Normal Saline 0,9% to the Bacterial Growth. Ortho Res Online J. 2018; 2(5): 175-8.
Patzakis MJ, Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res. 1989;(243): 36-40
Hoff WS, Bonadies JA, Cachecho R, Dorlac WC. East Practice Management Guidelines Work Group: Update to Practice Management Guidelines for Prophylactic Antibiotic Use in Open Fractures. The Journal of TRAUMA Injury, Infection and Critical Care. 2011;70(3): 751-4
Viscarra LF, Lozano L, Rios J, Forga MT, Soriano A. Preoperative Nutritional Status and Post-operative Infection in Total Knee Replacements: A Prospective Study of 213 Patients. Int J Artif Organs 2011; 34 (9): 876-881
Bohl DD, Shen MR, Kayupov E, Della Valle CJ. Hypoalbunemia independently Preduct Surgical Site Infection, Pneumonia, Length os Stay, and Readmission After Total Joint Arthroplasty. The Journal of Arthroplasty 31 (2016) 15–21
Singh J, Rambani R, Hashim Z, Raman R, Sharma HM. The Relationship Between Time to Surgical Debridement and Incidence of Infection in Grade III Open Fracture. Strat Traum Limb Recon (2012) 7:33–37
Diwan A, Eberlin KR, Smith RM. The Principles and Practice of Open Fracture Care, Chinese Journal of Traumatology xxx (2018) 1-6
Doshi P, Gopalan H, Pradhan C, Kurkani S, Bhandari M. Incidence of infection following internal fixation of open and closed tibia fractures in India (INFINITI): a multi-centre observational cohort study. BMC Musculoskeletal Disorders. 2017;18:156
Gosselin RA, Robert I, Gillespie WJ. Antibiotics for preventing infection in open limb fractures. Cochrane database syst rev. 2004; (1): CD003764
Brown KV, Walker JA, Cortez DS, Murray KC, Wenke JC. Earlier Debridement and Antibiotic Administration Decrease Infection. J Surg Orthop Adv. 2010; 19(1): 18-22.
Das R, Singh A, Srivastava P, Pradhan S, Murthy R. Microbial Profile and Antibiotic Susceptibility Pattern of Sugical Site Infection in Orthopedic Patients at a Tertiary Hospital in Bilaspur. Int J Sci Stud. 2015;3(3):43-7
Oliveira PR, Carvalho VC, Felix CS, Paula AP, Santos-Silva J, Lima ALLM. The incidence and microbiological profile of surgical site infections following internal fixation of closed and open fractures. Rev Bras Ortop. 2016;41(4):396-9.
Amaradeep G, Prakah S, Manjappa. Surgical site infections in orthopedic implant surgery and its risk factors: A prospective study in teaching hospital. Int J Orthop Sci. 2017;3(3): 169-72
Brooks, G. F., K. C. Carroll, J. S. Butel, S. A. Morse, dan T. A. Mietzner, Jawetz, Melnick, & Adelberg’s Medical Microbiology 26th Edition. America. The McGraw-Hill Companies, Inc. 2013.
Kalmeijer MD, Coertjens H, Nieuwland-Bollen PM, Bogaers-Hofman D, Baere GAJ, Stuurman A, et al. Surgical Site Infections in Orthopedic Surgery: The Effect of Mupirocin Nasal Ointment in a Double-Blind, Randomized, Placebo Controlled Study. Clinical Infectious Diseases. 2002;35:353-8.