A Comparison of Superficial and Deep Bacterial Presence in Open Fractures of the Lower Extremities

Abstract

This open prospective study compared the bacterial flora of superficial and deep-wound biopsies and swabs over a 2-year period in 4 different samples cultured from open fracture wounds at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Samples were taken from 47 patients with factures graded according to Gustilo and Anderson’s classification as grade 1 (2.1%), grade II (29.8%), grade IIIA (36.2%), and grade IIIB (31%). A total of 248 samples were cultured using standard techniques. The incidence of open fracture wounds was 78.7% in male patients and 21.3% in female patients. Tibia fractures constituted 66.1%. A total of 203 bacterial isolates were cultured from 248 samples. Gram-negative bacteria constituted 53.2% of isolates, with Escherichia coli being predominant (12.8%). Staphylococcus aureus were the predominant Gram-positive cocci (15.3%), and Staphylococcus epidermidis (13.3%) may be considered to be the major source of open fracture wound contamination. The bacterial species cultured from superficial and deep-wound swabs and biopsies were similar. Resistance to antimicrobials was high for penicillins (amoxicillin and cloxacillin), with values of 68.6% and 58.3%, respectively, for superficial bacterial species and 58.2% and 31.9%, respectively, for deep-wound biopsies.

Keywords

open fracture wounds bacteria flora superficial deep

Get full access to this article

View all access options for this article.

References

Sungaran J. , Harris I. , Maurad M. The effect of time to theatre on infection rate for open tibia fractures. ANZ J Surg 2007; 77:815. 2.

Neubauer T. , Bayer GS , Wagner M. Open fractures and infection. Acta Chir Orthop Traumatol Cech 2006;73:301-12. 3.

Blease R. , Kanlic E. Management of open fracture. Bosn J Basic Med Sci 2005;5 (4):14-21.

Gossling HR , Pillsbury SL Complications of fracture management. 1sted. Philadelphia: Lippincott; 1984.

Solagberu BA , Adekanye AO , Ofoegbu CPK , Kuranga SA , Udoffa US , Abdur-Rahman LO , et al. Clinical spectrum of trauma at a university hospital in Nigeria. Eur J Trauma 2002;28:365-9. 6.

Gustilo RB , Anderson JT Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 1976;58:453-8.

Patzakis MJ , Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res 1989;243:36-40. 8.

Worlock P. Frontiers in fracture management. In: Bunker TD , Colton CL , Webb JK. editors. The prevention of infection in open fractures. London: Martin Dunitz; 1989. p. 16-28.

Monson TP , Nelson CL Microbiology for orthopaedic surgeons, selected aspects. Clin Orthop Relat Res. 1984;190:14-22.

10.

Lawrence RM , Hoeprich PD , Huston AC Quantitative microbiology of traumatic orthopaedic wounds. J Clin Microbiol 1978;8:673-5.

11.

Skaggs LD , Friend L. , Alman B. , Chambers HG , Schmitz BL , Kay RM , et al. The effect of surgical delay on acute infection following 554 open fractures in children. J Bone Joint Surg Am 2005;87:8-12.

12.

Robinson D. , On E. , Hadas N. , Halperin N. , Hofman S. , Boldur I. Microbiologic flora contaminating open fractures: its significance in the choice of primary antibiotic agents and the likelihood of deep wound infection. J Orthop Trauma 1989 ;3:283-6.

13.

Crowley DJ , Kankaris NK , Glannoudis PV Irrigation of the wounds in open fractures. J Bone Joint Surg Br 2007;89:580-5.

14.

Ikem IC , Oginni LM , Bamgboye EA , Ako-Nai AK , Onipede AO The bacteriology of open fractures in Ile-Ife, Nigeria [published erratum appears in Niger J Med 2005;14:461]. Niger J Med 2004;13:359-365.

15.

Alonge TO , Ogunlade SO , Salawu SA , Fashina AN Microbial isolates in open fractures seen in the accident and emergency unit of a teaching hospital in a developing country. West Afr J Med 2002;21:302-4.

16.

Ako-Nai AK , Ikem IC , Akinloye OO , Aboderin AO , Ikem RT , Kassim OO Characterization of bacterial isolates from diabetic foot infections in Ile-Ife, Southwestern Nigeria. Foot 2006;16:158-64.

17.

Hankin L. , Anagnostakis SL The use of solid media for detection of enzyme production by fungi . Mycologia 1975;67:597-607.

18.

Jeffries CD , Holtoman DF , Guse DG Rapid method for determining the activity of microorganisms on nucleic acids. J Bacteriol 1957;73:590-1.

19.

Bauer AW , Kirby WMM , Sherris JC , Turck MA Antibiotic susceptibility testing by a standardized single disc method . Am J Clin Pathol 1966;45:493-5.

20.

National Committee for Clinical Laboratory Standards. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. 4th ed. Wayne, PA: National Committee for Clinical Laboratory Standards ; 1997.

21.

Ordog GJ , Sheppard GF , Wasserberger JS , Balasubramanium S. , Shoemaker WC Infection in minor gunshot wounds. J Trauma 1993;34: 358-65.

22.

Ikem IC , Oginni LM , Bamgboye EA Open fractures of the lower limb in Nigeria. Int Orthop 2001;25:386-8.

23.

D’Souza A. , Rajagopalan N. , Amaravati RS The use of qualitative cultures for detecting infection in open tibia fractures. J Orthop Surg (Hong Kong) 2008;16:175-8.

24.

Hammond SA , Morgan JR , Russell AD Comparative susceptibility of hospital isolates of Gram negative bacteria to antiseptics and disinfectants. J Hosp Infect 1987;9:255-64.

25.

Levine NS , Lindberg RB , Mason AD , Puitt BA The quantitative swab and swear: a quick, simple method for determining the numbers of viable bacteria on open wounds. J Trauma 1976;16:89-94.

26.

Lee J. Efficacy of cultures in the management of open fractures. Clin Orthop Relat Res 1997;(339):71-5.