A Case Report: Surgical Site Infection of Open Fracture Grade IIIC Caused by Methicillin-Resistant Staphylococcus aureus (MRSA)
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Abstract
Introduction: Based on World Health Organization (WHO) data in 2016, Surgical Site Infections (SSIs) occur in 11% of patients undergoing the procedure operations in developing countries. Overall, Staphylococcus aureus was the commonest bacteria isolated of the cultures in the postoperative period. Now, its considered endemic to most hospitals as Hospital Associated MRSA. Case History and Examination: A 60-year-old male presented to Rumah Sakit Daerah (RSD) dr. Soebandi Jember with a severe open fracture of his right lower extremity (cruris dextra) after hit by a truck. Patient came with massive bleeding because the rupture of tibial and femoral arteries. He had already given initial prophylactic antibiotic treatment such as cefazolin and amoxicillin before the operative procedure. After more than 3 months, he suffered a pyogenic infection with a biofilm plaque formation on his surgical sites. Microbiology Examination and Diagnosis: This Staphylococcus aureus resisted to 12 of 18 antibiotics that was tested including beta-lactams and macrolides groups of antibiotics. Treatment and Course: This case has already reported to the hospital and the patient was given topical Gentamicin and oral Clindamycin. Discussion: The initial mistreatment of fracture really becomes the risk factor of surgical site infection, and also this patient’s condition included significant risk factors for SSI because of his age, location of injury cleanliness, and high-energy injury. Conclusion and Recommendations: This case report of SSI in a postoperative of severe open fracture can be used to evaluate the empirical treatment that is used in RSD dr. Soebandi Jember.
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References
Azar F, Beaty J, Campbell W, Canale S. (2012).Campbell's Operative orthopaedics.
Bonnevialle, P. (2017). Operative treatment of early infection after internal fixation of limb fractures (exclusive of severe open fractures). Orthopaedics & Traumatology: Surgery & Research, 103(1). doi: 10.1016/j.otsr.2016.06.019
Carroll, K. C., Morse, S. A., Mietzner, T., & Miller, S. (2016). Jawetz, Melnick & Adelbergs medical microbiology (27th ed.). New York: McGraw-Hill Education.
Doshi, P., Gopalan, H., Sprague, S., Pradhan, C., Kulkarni, S., & Bhandari, M. (2017). Incidence of infection following internal fixation of open and closed tibia fractures in India ( INFINITI ): a multi-centre observational cohort study, 1–10. https://doi.org/10.1186/s12891-017-1506-4
Fernandes M, Peres L, QueirozNeto A, Lima Neto J, Turíbio F, Matsumoto M. (2015) Open fractures and the incidence of infection in the surgical debridement 6 hours after trauma. ActaOrtopédica Brasileira.;23(1):38-42
Ghoshal, A., Enninghorst, N., Sisak, K., & Hunter, F. J. (2010). An interobserver reliability comparison between the Orthopaedic Trauma Association ’ s open fracture classification and the Gustilo and Anderson classification, 242–246. https://doi.org/10.1302/0301-620X.100B2.BJJ-2017-0367.R1
Global Guidelines for the Prevention of Surgical Site Infection. Geneva: World Health Organization; (2018). 3, Important Issues in the Approach to Surgical Site Infection Prevention. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536426/
Gupta, S., Saini, N., Sharma, R., Kehal, J., & Saini, Y. (2012). A Comparative Study Of Efficacy Of Pre And Post Debridement Cultures In Open Fractures, 19(3), 1–7.
Kathju S, Nistico L, Tower I, Lasko L, Stoodley P. Bacterial Biofilms on Implanted Suture Material Are a Cause of Surgical Site Infection. (2014);15(5):592–600.Available from: http://dx.doi.org/10.1089/sur.2013.016
Kim, P. H., & Leopold, S. S. (2012). Gustilo-Anderson Classification, 3270–3274. https://doi.org/10.1007/s11999-012-2376-6
Kostakioti, M., Hadjifrangiskou, M., Hultgren, S. J., Hayes, C. S., Koskiniemi, S., Ruhe, C., … Gorvel, J. (2014). Bacterial Biofilms : Development , Dispersal , and Therapeutic Strategies in the Dawn. https://doi.org/10.1101/cshperspect.a010306
Luther MK, Parente DM, Caffrey AR, Daffinee KE, Lopes VV, Martin ET, LaPlante KL. (2018). Clinical and genetic risk factors forbiofilm-forming Staphylococcus aureus. Antimicrob Agents Chemother62:e02252-17. doi:10.1128/AAC.02252-17Available at:http://dx.doi.org/10.1128/AAC.02252-17
Mangala, A., Arthi, K., & Deepa, R. (2018). Comparison of Predebridement and Debridement Cultures in Predicting Postoperative Infections in Compound Fractures, 12(7), 10–13. https://doi.org/10.7860/JCDR/2018/36011.11735
Masanori Toyofuku, Tomohiro Inaba, Tatsunori Kiyokawa, Nozomu Obana, Yutaka Yawata & Nobuhiko Nomura (2016) Environmental factors that shape biofilm formation, Bioscience, Biotechnology, and Biochemistry, 80:1, 7-12, DOI: 10.1080/09168451.2015.1058701
Metsemakers, W. J., Kuehl, R., Moriarty, T. F., Richards, R. G., Verhofstad, M. H. J., Borens, O., … Morgenstern, M. (2018). Infection after fracture fi xation : Current surgical and microbiological concepts. Injury, 49(3), 511–522. https://doi.org/10.1016/j.injury.2016.09.019
Msed, B. N. G., Msed, C. D. J., Todd, J., Dc, E., Michael, C. D. R., Pt, R., … Dc, E. (2012). Methicillin-resistant Staphylococcus aureus : an overview for manual therapists . Journal of Chiropractic Medicine, 11(1), 64–76. https://doi.org/10.1016/j.jcm.2011.12.001
National Collaborating Centre for Women's and Children's Health (UK). Surgical Site Infection: Prevention and Treatment of Surgical Site Infection. London: RCOG Press; (2008) Oct. (NICE Clinical Guidelines, No. 74.) 1, Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK53735/
Oliveira, P. R., Carvalho, V. C., Felix, S., Paula, A. P. De, Santos-silva, J., Lucia, A., & Munhoz, L. (2016). The incidence and microbiological profile of surgical site infections following internal fixation of closed and open fractures ଝ. Revista Brasileira de Ortopedia, 51(4), 396–399. https://doi.org/10.1016/j.rboe.2015.09.012
Orthoinfo.aaos.org. (2019). Open Fractures - OrthoInfo - AAOS. [online] Available at: https://orthoinfo.aaos.org/en/diseases--conditions/open-fractures/ [Accessed 1 Oct. 2019]
Riedel S, Hobden J, Miller S, Morse S, Mietzner T, Detrick B et al. (2019).Jawetz, Melnick&Adelberg's medical microbiology. 28e. McGraw-Hill Education
Sun, Y., Wang, H., Tang, Y., Zhao, H., Qin, S., Xu, L., … Zhang, F. (2018.). Incidence and risk factors for surgical site infection after open reduction and internal fi xation of ankle fracture.
Wolfensberger A, Sax H, Weber R, Zbinden R, Kuster S, Hombach M. Change of Antibiotic Susceptibility Testing Guidelines from CLSI to EUCAST: Influence on Cumulative Hospital Antibiograms. PLoS ONE. 2013;8(11):e79130.
World Health Organization (WHO). (2016). Surgical Site Infections (SSI)
Zhu, H., Li, X., & Zheng, X. (2017). A Descriptive Study of Open Fractures Contaminated by Seawater : Infection , Pathogens , and Antibiotic Resistance, 2017.
Orthoinfo.aaos.org. (2019). Open Fractures - OrthoInfo - AAOS. [online] Available at: https://orthoinfo.aaos.org/en/diseases-- conditions/open-fractures/ [Accessed 1 Oct. 2019]
Riedel S, Hobden J, Miller S, Morse S, Mietzner T, Detrick B et al. (2019).Jawetz, Melnick&Adelberg's medical microbiology. 28e. McGraw-Hill Education
Sun, Y., Wang, H., Tang, Y., Zhao, H., Qin, S., Xu, L., … Zhang, F. (2018.). Incidence and risk factors for surgical site infection after open reduction and internal fi xation of ankle fracture.
Wolfensberger A, Sax H, Weber R, Zbinden R, Kuster S, Hombach M. Change of Antibiotic Susceptibility Testing Guidelines from CLSI to EUCAST: Influence on Cumulative Hospital Antibiograms. PLoS ONE. 2013;8(11):e79130.
World Health Organization (WHO). (2016). Surgical Site Infections (SSI)
Zhu, H., Li, X., & Zheng, X. (2017). A Descriptive Study of Open Fractures Contaminated by Seawater : Infection , Pathogens , and Antibiotic Resistance, 2017.