A Study on the Incidence, Bacteriological Profile and Risk Factors of Infections in Open Fractures of Long Bones in a Tertiary Care Hospital

INTRODUCTION: Open fractures are fractures which communicate to the external environment through a wound, exposing the bone. They are also referred to as compound fractures. Bacterial contamination is reported to occur in 60-70% of the cases which may be responsible for the infectious complications in these patients. Infection is a common complication that occurs in all these cases. Other complications of open fractures include non-union, malunion, osteomyelitis, deep seated infections and even functional loss of the limb. The exposed fracture site, presence of devascularised tissue, severity of the external wound, presence of comorbid conditions in the patient, immune status of the patient, delay in arrival to the hospital and delay in treatment are a few reasons that determine the occurrence of infection. AIM OF THE STUDY: To determine the incidence and risk factors of infections in open fractures of long bones, to identify the bacteria causing infections and their antimicrobial susceptibility pattern. MATERIALS AND METHODS: Between September 2015 and August 2016, 100 patients who sustained Open fractures of long bones were included in the study. Swabs were collected from the fractured wound for pre debridement cultures, a piece of tissue at the time of debridement and a swab specimen again in the event of suspicion of infection in the post operative period. RESULTS: Incidence of infection in the post operative period was found to be 39%, among which only 21% of patients had a positive culture on pre debridement whereas 66% had positive cultures at the time of debridement. Debridement culture were found to be more sensitive. Gram negative bacteria were the predominant pathogens in 77.5% of the cultures. Gram stain proved to be useful screening tool. The correlation between Diabetes and Infection was found to be statistically significant. CONCLUSION: Debridement cultures are sensitive and valuable in guiding the choice of antimicrobial therapy which when combined with a thorough wound debridement will enable early wound closure and lesser complications