Incidence of post-operative wound infections and bacterial antibiotic sensitivity patterns amongst elective orthopaedic surgery patients at Mulago hospital
Otieno, Oliver Soren
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Infections is an uncommon, but occasionally a devastating complication of orthopaedic surgery. If infection occurs, the patients are at risk of loosing their newly found mobility, loose their independence, be hospitalised with sepsis, both local and systemic, and perhaps die. This study was carried out to determine the incidence of early superficial POWI, the bacterial isolstes responsible for POWI and their Antibiotic sensitivity patterns. METHODOLOGY: This was a cross-sectional descriptive study involving 130 patients who underwent an elective orthopedic surgical operation in orthopedic theatre (ward 7 theatre) of Mulago hospital, kampala, Uganda, between August 2004 and January 2005. Patients demography, clinical features, duration of hospital stay, antibiotic prophylaxis given and operation duration were reported. Swabs were collected 48 hours after operation from all post operative wounds for aerobic culture, bacterial isolation and antibiotic sensitivity testing. Data was collected and analyzed using SPSS version 10.0. Incidence of wound infection per 100 elective orthopedic patients was calculated. Chi- square test was used to assess for the association between categorical variables and wound infection. All levels of statistical association were established at p<0.05. Results are presented using tables, pie-charts, bar graphs and pictures. RESULTS: Eighteen (18) bacterial isolates were cultured and associated from sixteen (16) of the 130 patients whose postoperative wound swabs were studied. There were 4 cases (3.1%) of contamination and 10 cases (7.7%) of sterile pus. The incidence of early superficial POWI is 12.3% (16/130) amongst patients undergoing elective orthopedic surgery in Mulago hospital. In descending order, the bacterial isolates were as follows; Staphylococcus aureus: Coagulase negative staphylococcus, Escherichia coli, pseudomonas and klebsiella and others. The majority of the bacteria isolated were resistant to the routinely used antibiotics, cloxacillin 13/18 (72.8%) and gentamicillin 7/18 (38.2%). There were 62.5%(5/8) cases of methicillin resistant staphylococcus aureus (MRSA) were. Of the associated findings studied, Total days of hospital stay before surgery (p=0.008), duration of surgical procedure (p=0.002) and repeated surgery (p=0.045) were noted to have significantly association with occurance of early superficial POWI amongst patients undergoing elecetive orthopedic surgery in mulago hospital. CONCLUSION AND RECOMMENDATION: The incidence of early superficial POWI in orthopedic surgery of mulago hospital is relatively high. The main bacterial isolate causing POWI is staphylococcus aureus of which majority (62.5%) are resistant to methicillin. Sensitivity pattern of commonly used antibiotics (cloxacillin and gentamycillin) is variable and low. There is a need to study in depth the factors responsible for this high incidence of POWI as well as a need to institute a rational antibiotic prophylaxis regimen in orthopaedic surgery department of mulago hospital.