Bacterial flora in grade III open fractures produced by war injuries
DOI:
https://doi.org/10.1016/j.rccot.2017.07.006Keywords:
open fracture, grade III, war wound, antibiotic prophylaxis, antibiotic therapyAbstract
Background: War injuries such as those produced by modified antipersonnel mines generate extensive soft tissue damage and traumatic amputations, which are severely contaminated with soil, vegetation, faecal components, and even the tissues of other victims. The objective of the study is to establish the type of microorganisms that are isolated in these types of injuries.
Materials and methods: A case series was conducted between January 2012 and December 2014, which included all patients with wounds from gunshots, fragmentation weapons, or antipersonnel mines, who had bone-tissue involvement, bacteriological cultures of bone and / or soft tissues with definitive reports, and antibiotic sensitivity tests on isolated germs.
Results: Of the126 patients included, it was found that 72% had an open fracture grade IIIA, and 28% a grade IIIB fracture. Gram negative bacteria were the most isolated in cultures (41%). Enterococcus faecalis was the most frequently isolated bacterium (15%), followed by Pseudomonas aeruginosa (13%).
Discussion: It was shown that 52% of isolated germs had some type of resistance to the empirical antibiotic management that was applied as a protocol at the time of admission (cephalosporin + aminoglycoside and ciprofloxacin + clindamycin in case of fragmentation weapons). This sets a new medical and surgical challenge for all those responsible for the integral management of these kinds of patients.
Evidence level: III.
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