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Addis Ababa University Libraries Electronic Thesis and Dissertations: AAU-ETD! >
Faculty of Medicine >
Thesis - Medical Microbiology >
Please use this identifier to cite or link to this item:
http://hdl.handle.net/123456789/2609
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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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