Injury Characteristics, Infection and Resistance Pattern of Open Fracture Tibia in Tertiary Orthopaedic Centre

Abstract

Background: Open fractures are a frequent occurrence in the in accident and emergency department that requires immediate care. As a pedal bone, the tibia is very prone to accidental injury, easily becomes bare following the trauma and very prone to infection. Updated knowledge about microbial aspects of open tibia fracture infection is essential for proper management. Objective: This study evaluated the injury characteristics and resistance patterns of microorganisms involved in the infection of open fracture tibia in a single-centred study. Methods: This was a cross-sectional study on a total of 384 patients presented at the emergency department with open fractures of the tibia (all Gustilo types) from January 2020 to July 2020 at the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Bangladesh. Three successive culture sensitivity tests were carried out-one at the emergency room (surveillance culture), 2nd at the emergency theatre after debridement and third at ward after 1 week (7 to 10 days). Results: Average age of the patients was 36.2± 15.5 years, with motor vehicle accidents being the predominant cause (72.9%). Gustilo III fractures were most prevalent (54.4%). The maximum infection rate was in Gustilo IIIB Fractures (40.4%). There was a significant difference in contamination rate between on admission culture (37.0%) and post debridement culture (26.3%). The infection rate from the ward samples was 44.5 %, where the postdebidement contamination was less only 26.3%. But from the ward sample, it again increased to 44.5%. Among the patient entering the ward after debridement with no contamination (73.7%) became infected in 34.62% cases, which indicates hospital-acquired infection. The bacterial resistance patterns from the ward samples were more virulent with multidrug resistance, predominantly Pseudomonas spp. and Kliebsiella spp. Conclusion: The present study provided insight into the injury characteristics and infection patterns of open fractures of the tibia. Early debridement reduced the contamination, but there was still hospital-acquired infection with more virulent multidrug resistance phenotypes. Bangladesh Med Res Counc Bull 2021; 47(2): 205-211