Abstract

Introduction: Post traumatic osteomyelitis is one of the few infectious diseases which has become prevalent due to high speed motor vehicle accidents and orthopedic surgery. The deep infection rate in setting of open fracture ranges from 2 to 50% as trauma exposes bone by breaching host defences and provides ideal environment for colonisation.

After diagnosing chronic osteomyelitis, treatment is aimed at eradicating infection and to prevent recurrence. However osteomyelitis is often unresponsive to modern therapy and although mortality has been eliminated, it still often results in morbidity and disability. Management of chronic osteomyelitis with proper antibiotic therapy based on culture report is necessary for full cure. Though earlier studies gram positive organisms were the main pathogens, now other gram negative bacilli like pseudomonas and klebsiella are also frequently isolated from hospitalized patients and are commonly associated with recurrence.

Aim

1. Our study aims to find out the incidence of osteomyelitis in compound fracture patients, in a tertiary care centre.
2. To find the etiology and its antibiotic sensitivity so that effective pathogen directed treatment can be given.
3. To find incidence of ESBL AND MBL organisms causing infections.

Materials and Methods: A descriptive study of specimens collected from patients admitted under orthopaedic department wards in Govt medical college Trivandum from july 2013 to july 2014.

Patients aged more than 20 years age with clinical and radiological features of chronic osteomyelitis .About 150 patients who were admitted in the orthopedic wards during time period of one year was taken into consideration.

Data was obtained in structured proforma and correlated with their clinical history and sample collection  was done from each patient.

Results: Out of 150 patients studied with chronic osteomyelitis, open fractures were most associated with chronic osteomyelitis. More gram negative especially ESBL resistant organisms were isolated from cases. Moreover the number of MRSA cases were reduced compared to the previous study done in the same ward by Dr. Shanimole et al ¹.

Conclusion: Increased isolation of multidrug resistant organisms among cases imply the uncontrolled use of high level antibiotics in the initial stage itself. Moreover the implementation of proper MRSA isolation precautions lead to a dramatic decrease in MRSA cases in the ward compared to previous study. Etiology directed treatment yielded better cure rate during Follow up.

Keywords: ESBL- Extended spectrum beta lactamase MBL-Metallo beta lactamase, MRSA-Methicillin resistant staphylococcus aureus.