The occurrence of infection in open long-bone fractures among adult patients at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Open injuries of long bones are complex, with substantial implications for patients’ well-being. These injuries pose a significant challenge in orthopaedic surgery, as they are highly susceptible to infections that can compromise patient outcomes and increase morbidity and mortality. Identifying factors that are associated with the occurrence of infection among adult patients with open fractures of long bones can provide clinicians with information critical in making informed decisions regarding fracture management protocols, antibiotic selection, and preventive measures to reduce infection and improve patient outcomes. Objectives: To describe the characteristics, incidence, patterns of prophylaxis antibiotic use and to determine the factors associated with occurrence of infection in open long bones fractures among adult patients at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Methods: A prospective descriptive study which involved 247 adult patients with 258 open fractures of long bones admitted at MTRH Orthopaedics wards between January 2024 and September 2024. Data from the participants was collected using an interviewer-administered questionnaire. Data on socio-demographic and fracture characteristics, co-morbidities, Gustilo-Anderson classification, the time of injury, duration from injury to debridement, timing and duration of prophylactic antibiotics were recorded. Participants were followed up for 3 months to monitor for development of infection using the Center for Disease Control and Prevention (CDC) criteria based on clinical features and microbiological culture- sensitivity procedure. There were 230 participants with 241 fractures analyzed. Results: The majority of patients were male (74.3%) with a mean age of 36.9 (SD: 14.9) years. Road traffic accidents were the leading cause of fractures (65.2%), and lower extremity fractures were the commonest (82.2%), primarily affecting the tibia and fibula (57.3%). Comminuted fractures were the most frequent pattern (58.5%). The overall infection rate was 38.2%, with Staphylococcus aureus being commonest isolated organism (20.6%), followed by Escherichia coli (10.8%) and Proteus mirabilis (8.7%). Infection rates were significantly higher with delayed surgical debridement, increasing from 0% within 6 hours to 72.4% when delayed beyond 48 hours (p < 0.001). Other factors that increased risk of infection included Gustilo-Anderson type III fractures, especially type IIIB, had the highest infection rates (91.2%), smoking (p < 0.001) and diabetes (p = 0.038). Early prophylactic antibiotic administration reduced infection rates. Cefazolin was the commonest used prophylactic antibiotic, with a mean duration of 13.6 (SD: 4.6) days. Conclusion: Road traffic accidents were the primary cause of open long bone fractures, predominantly in young males. The infection rate was higher than documented elsewhere, risks being increased with delayed debridement and prophylactic antibiotics, type III fractures, smoking, and diabetes mellitus. Cefazolin was the commonest prophylactic antibiotic used beyond usual recommended 24 hours. Recommendation: Infection prevention strategies must be enhanced. Early surgical debridement and antibiotic administration should be prioritized and prophylactic antibiotics should follow a standardized protocol to avoid resistance and unnecessary healthcare costs. Public health initiatives should improve road safety and educate high risk groups.