Review of Antibiotics Usage in the Management Open Fracture in a Nigerian Hospital

Abstract

Background: Antibiotics are adjuncts in the management of open fractures, and microbial characteristic of open fractures will guide the use of antibiotics. With changing pattern in microbial colonization of wounds, the need to review antibiotic usage in hospitals becomes imperative. The study aimed to evaluate the antibiotic protocol of managing open fractures at the Accident and Emergency department, with the advent of new antibiotics introduced into the hospital drug formulary. Materials and Methods: This study is a hospital-based prospective evaluation of the antibiotic sensitivity of cultured microorganisms from the patients with open fractures presenting between January 2013 and December 2013 in the Accident and Emergency Department, of a tertiary hospital in Nigeria. Swabs of superficial and deeper parts of the wound were taken at the presentation of the patients before wound debridement and commencement of antibiotics. Other two samples and biopsies were taken at the deeper parts of the wound on the 3rd and 7th day of admission. Culture and Sensitivity pattern of isolates were determined for positive cultures using antibiotics impregnated discs. Descriptive and inferential statistics of the findings are presented. Results: One hundred and thirty patients with open fractures were recruited for the study, but 81 patients completed the study. Forty patients discharged themselves against medical advice and while nine patients were referred to other hospitals.  Sterile swabs were taken from the surface and deeper portion of the wounds at a presentation before treatment was commence and at day 3 and day 7 of admission, Staphylococcus aureus and Clostridium perfringens were the most common aerobic and anaerobic isolates from the wounds respectively. The aerobic isolates and anaerobes were susceptible to ceftriaxone, ciprofloxacin, co-Amoxyclav, gentamycin, and cefotaxime and metronidazole respectively.  Conclusion: The antibiotic sensitivity pattern in the emergency department of the Hospital has not changed significantly as previously reported about 12 years earlier. Therefore, the hospital antibiotic protocol in the treatment of open fractures in the Accident and Emergency department should be retained.