Pre- and Post-debridement Wound Cultures in Gustilo Type III Open Tibial Fractures to Predict Wound Infection at a Tertiary Care Hospital

TL;DR

This study examines how wound cultures before and after debridement can predict infections in severe tibial fractures, finding that hospital-acquired infections are common.

Contribution

The study introduces a method using pre- and post-debridement wound cultures to predict wound infection in Gustilo type III open tibial fractures.

Findings

Pre-debridement wound cultures showed a significant correlation with wound infections.

Post-debridement cultures also correlated with wound infections, but contamination rates decreased after debridement.

Hospital-acquired infections were prevalent, with Pseudomonas and Klebsiella being the most common multidrug-resistant bacteria.

Abstract

Background: Gustilo type III open tibial fractures are difficult injuries that carry a higher risk of infection and other consequences. Open-fracture wound microbiology is dynamic and responsible for change over time. Effective antibiotic treatment plans are required, as detrimental microorganisms are often linked to these types of lesions.

Objectives: The study aimed to determine whether pre- and post-debridement wound cultures could predict wound infection in Gustilo type III open tibial fractures.

Methods: This prospective study was carried out at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) in Dhaka, Bangladesh, on 344 patients who presented to the emergency department with a Gustilo type III open tibial fracture within 24 hours of injury from June 2018 to October 2019. Three successive cultures were carried out: one in the emergency room (surveillance culture), the second at the emergency theater after debridement, and the third in the ward after one week (seven to 10 days). Statistical analyses of the results were conducted using Microsoft Excel (Microsoft Corp., Redmond, WA) and IBM SPSS Statistics for Windows, version 27 (IBM Corp., Armonk, NY).

Results: The study included 344 patients with an average age of 37.15 years, with motor vehicle accidents being the primary cause (78.2%). Gustilo type IIIA fractures made up the majority (48.5%), followed by type IIIB fractures (44.8%). A significant reduction in contamination rates was observed from initial admission (48.8%) to post-debridement (36.6%) (p =.001). There was a significant positive correlation between pre-debridement cultures and wound infections (r =.311), as well as between post-debridement cultures and wound infections. The infection rate increased to 61.6% in ward samples, indicating a high rate of hospital-acquired infections. Pseudomonas and Klebsiella species were the most prevalent multidrug-resistant bacteria that caused these infections.

Conclusion: The present study provides information on the relationship between contamination and infection. Gram-negative pathogens were dominant in this study, and the results of the antibiograms showed an alarming pattern of resistance. Nosocomial infection demands further urgent study.

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