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Title: Bacteriology of Open Fracture Wounds in Tikur Anbessa University Hospital Addis Ababa, Ethiopia
Authors: Yishak, Abraham
Advisors: Daniel Asrat, Associate Professor (MD, M.Sc, PhD)
Dr. Yimtubezinash W/Amanuel, Associate Professor (MD, M.Sc, PhD
Keywords: Open fracture wounds,
Bacterial isolates
Antimicrobial susceptibility testing
Copyright: May-2009
Date Added: 4-May-2012
Publisher: AAU
Abstract: Open fractures are those exposed to the out side environment through a skin wound. They are at risk of complications such as infected non-union and other co-morbid conditions. Sixty to seventy percent of compound fractures are believed to be contaminated with bacteria at the time of injury from both skin and environment. Infection of open fractures depends on the microbial and host factors. In Ethiopia, a high incidence of open fracture wound infection is suspected though the magnitude of the problem is not known. No documented report on bacterial isolates from open fracture wounds and their drug resistance pattern. During a period of November 2007 and May 2008, a cross-sectional prospective study was conducted to determine the bacteriology of open fracture wounds of 191 informed and consented patients who visited the orthopedic surgery department of Tikur Anbessa University Hospital, Addis Ababa, Ethiopia. The modified Gustilo and Anderson (G-A) grading of open fractures based on severity and extent of soft-tissue injury was used to categorize the open fractures. The clinical features of the open fracture wounds were assessed and wound swab specimens were collected using Levine’s technique from each patient. All of the wound specimens were processed for microscopic examination, culture and sensitivity testing. The causes of the fractures varied, but most of the open fractures were caused by car accidents (37.2%) and occurred in lower extremities bones (60.0%). Of the 191 patients, 82.7% were males and 17.3% were females (p < 0.05) resulting in an overall male to female ratio of 4.8:1. The average age of the patients was 31.55 years (age range 4 to 75 years). According to G-A grading, 23.0% of the fractures were grade I; 41.5% were grade II; 14.0% were grade IIIA; 5.5% were grade IIIB and 16.0% were grade IIIC. Of the 200 wound specimens examined by gram stain, 30.5% were positive for the presence of bacteria. Out of the 200 wound specimens cultured, 82 (41%) were positive for bacteria. Of the culture-positive wounds, 51.2% showed mono-microbial growth and 48.8% showed polymicrobial growth. In general, a total of 162 bacterial pathogens were isolated from the open fracture wounds sampled. Staphylococcus aureus was the dominant isolate (14.8%) followed by Acinetobacter spp. (11.4%). The gram-positive and gram-negative bacteria accounted for 34.0% and 66.0%, respectively (p< 0.05). All gram-positive bacterial isolates showed low level of resistance (<60%) to all antibiotics tested except for ampicillin and penicillin to which they showed intermediate level of resistance (60-80%). Most gramviii positive isolates, 29/55 (52.7%) showed multiple drug resistance (resistance to three or more drugs). All Clostridium spp. were susceptible to tetracycline, doxycycline, and kanamycin and showed low level of resistance (<60%) against chloramphenicol, clindamycin and penicillin. All gram negative bacterial isolates showed low level of resistance (<60%) to all antibiotics tested except for ampicillin and amoxicillin (60-80%, intermediate level resistance). Fifty-one percent of the gram negative bacterial isolates were identified as multiple drug resistant. In conclusion, the present study showed that road traffic accident was the commonest cause of open fractures. Most fractures occurred in lower extremities. Staphylococcus aureus was the commonest isolate associated with open fracture wound infection. Gentamicin, ciprofloxacin and norfloxacin were the most effective drugs against the tested gram positive and gram negative bacteria. The findings of this study will give valuable information for establishing empiric therapeutic approaches for the management of open fracture wound infections. In addition, the findings underscore the need for routine microbiological investigation of open fracture wounds and monitorring antimicrobial resistance pattern for the use of prophylactic and therapeutic antimicrobials. Key words: Open fracture wounds, Bacterial isolates, Antimicrobial susceptibility testing
URI: http://hdl.handle.net/123456789/2609
Appears in:Thesis - Medical Microbiology

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