SURGICAL SITE INFECTION IN ORTHOPEDIC IMPLANTS AND ITS COMMON BACTERIA WITH THEIR SENSITIVITIES TO ANTIBIOTICS, IN OPEN REDUCTION INTERNAL FIXATION
AbstractBackground: Surgical site infection in orthopaedic implants is a major problem, causing long hospital stay, cost to the patient and is a burden on health care facilities. It increases rate of non-union, osteomyelitis, implant failure, sepsis, multiorgan dysfunction and even death. Surgical site infection is defined as pain, erythema, swelling and discharge from wound site. Surgical site infection in orthopaedic implants is more challenging to the treating orthopaedic surgeon as the causative organism is protected by a biofilm over the implant’s surface. Antibiotics cannot cross this film to reach the bacteria’s, causing infection. Method: This descriptive case series study includes 132 patients of both genders with ages between 13 years to 60 years conducted at Orthopaedic Unit, Ayub Medical College, Abbottabad from 1st October 2015 to 31st March 2016. Patients with close fractures of long bones were included in the study to determine the frequency of surgical site infection in orthopaedic implants and the type of bacteria involved and their sensitivity to various antibiotics. All implants were of stainless steel. The implants used were Dynamic hip screws, Dynamic compression screws, plates, k-wires, Interlocking nails, SIGN nails, Austin Moore prosthesis and tension band wires. Pre-op and post-op antibiotics used were combination of Sulbactum and Cefoperazone which was given 1 hour before surgery and continued for 72 hours after surgery. Patients were followed up to 4 weeks. Pus was taken on culture stick, from those who developed infection. Results were entered in the pro forma. Results: A total of 132 patients of long bone fractures, who were treated with open reduction and internal fixation, were studied. Only 7 patients developed infection. Staphylococcus Aureus was isolated from all 7 patients. Staphylococcus aureus was sensitive to Linezolid, Fusidic Acid, and vancomycin. Cotrimoxazole, tetracycline, Gentamycin and Clindamycin were partially effective. Conclusion: Surgical Site Infection is common in orthopaedic implants, occurring in 5.30% cases. Staphylococcus aureus is the common bacteria, causing it.Keywords: Surgical site infection; Orthopaedic implants; Open reduction internal fixation; Close fracture
Salman M, Khan MA, Gul T, Bilal M, Kamran W. Frequency of surgical site infection in orthopedic implants surgery with its common bacteria and antibiotic sensitivity. Pak J Surg 2014;30(2):167–71.
Cheadle WG. Risk factors for surgical site Infection. Surg Infect. Surg Infect (Larchmt) 2006;7(Suppl 1):S7–11.
Strachan CJ. The prevention of orthopedic implant and vascular graft infections. J Hosp Infect 1995;30:54–63.
Nair PK, Bhat VG, Vaz MS. Clinical infectious diseases. World J Chin Infect Dis 2014;25(8):9–15.
Zimmerli W. Clinical presentation and treatment of orthopedic implant associated infection. J Intern Med 2014;276(2):111–9.
Ikeanyi UO, Chukwuka CN, Chukwvanukwv TO. Risk factors for surgical site infections following clean orthopedic operations. Niger J Clin Pract 2013;16(4):443–7.
Leaper D. Surgical infection. In: Williams NS, Bailey H, Bulstrode CJ, Love RM, O’Connell PR, editors. Bailey & Love’s short practice of surgery. 25th ed. landon: Hodder Arnold; 2008. p.32–48.
Khan MS, Rehman SU, Ali MA, Sultan B, Sultan S. Infection in Orthopedic implant surgery, its risk factors and outcome. J Ayub Med Coll Abbottabad 2008;20(1):23–5.
Khan MS, Ahmed Z, Jehan S, Fasseh-uz-Zaman, Khan S, Zaman S, et al. Common trend of antibiotics usage in a tertiary care hospital of Peshawar, Pakistan. J Ayub Med Coll Abbottabad 2010;22(1):118–20.
Mulhim FFA, Baragbah MA, Sadat-Ali M, Alomran AS, Azam MQ. Prevalance of surgical site infection in orthopedic surgery: a 5 year analysis. Int Surg 2014;99(3):264–8.
Jain RK, Shukla R, Singh P, Kumar R. Epidemiology and risk factors for surgical site infections in patients requiring orthopedic surgery. Eur J Orthop Surg Tramatol 2014;8(5)251–4.
Abdel-Fattah MM, Surveillance of nosocomial infection at a Saudi Arabian Military hospital for a one year period. Ger Med Sci 2005;3:1–10.
Slama TG, Amin A, Brunton SA, File TM Jr, Milkovich G, Rodvold KA, et al. A Clinician’s guide to the Appropriate and Rational Antibiotic Therapy (CART) Criteria. Am J Med 2005;118(Suppl 7A):S1–6.