BACTERIAL INFECTION IN SURGICAL WOUND AFTER ORTHOPEDICS TRAUMA SURGERY AT THE TAMALE TEACHING HOSPITAL IN THE NORTHERN REGION OF GHANA

Abstract

Background: Orthopedic trauma surgery (OTS) can result in surgical site infections (SSIs), and the repercussions include prolonged and increased cost of treatment. This study sought to investigate surgical site infection after orthopedics trauma surgery. Methods: A prospective cohort study was conducted at the Tamale Teaching Hospital from September 2023 to August 2024. Data on demographics, comorbidities, preoperative, intra-operative, and postoperative parameters were collected from patients, medical records, and the operation report. Samples were collected from patients suspected of SSI, and cultured for bacterial isolation, identification and antimicrobial resistance characterization. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors of surgical site infection. P-value <0.05 was considered statistically significant. Surgical site infection was defined following the Center for Disease Control and Prevention (CDC) criteria. Results: A total of 210 patients were enrolled, of which 6.7% (14) developed SSIs, including 1.0% (2) deep and 5.7% (12) superficial SSIs. The study reported a maximum and minimum age of 86 years and 0.67 years (8 months), respectively. The median age (Interquartile range) reported in this study was 35.5 (18 - 47). The incidence rate of SSI in open fractures and closed fractures in this study was 3.3% (7) and 2.9% (6), respectively. According to multivariate regression analysis, blood transfusion before surgery (p=0.034; OR=3.53; 1.10 – 11.33), was identified as an independent risk factor of SSI following OTS. Out of 19 specimens, 14(73.68%) were culture-positive, yielding 22 isolates. Pseudomonas aeruginosa 5 (22.73%) was the most common bacterial isolate, followed by Klebsiella spp. 4 (18.18%). ESβL-positive isolates were 3(23.08%). PCR confirmed the expression of CTXM and SHV genes by two Klebsiella spp., and the CTXM gene by Proteus vulgaris. Conclusion: The study reported the incidence rate of SSI after OTS to be 6.7% (67 per 1000 surgical operations) within one year. Blood transfusion before surgery was identified as an independent risk factor of SSI following OTS. ESβL positive isolates were 3(23.08%). PCR confirmed the expression of CTXM and SHV genes by two Klebsiella spp., and CTXM gene by Proteus vulgaris.