Incidence, Etiological Profile, and Treatment of Surgical Site Infections in Patients With Gunshot Injuries and Bomb Blast Injuries in Pakistan

Abstract

Purpose: There are few reports on surgical site infections (SSI) after blast injuries. Those occurring in developing nations are a particular source of interest given the recent war in the Middle East. The purpose of this study was to report the incidence, etiological causative agents, and treatment of SSI in patients with gunshot and blast injuries. Methods: A prospective study was performed between January 2008 and December 2008. One thousand four hundred sixteen (1416) patients with gunshot injuries and bomb blast injuries were identified. Three hundred eighty-two patients (27%) were lost to follow-up. Data were collected from bacteriology reports of all surgical site samples and presentation of patients at follow-up. Results: One hundred forty-seven patients (14.2%) developed SSI. Culture reports were positive in one hundred twenty-four patients (84.4%). Only one etiological agent was isolated in 146 patients (99.3%). The most common pathogen was Staphylococcus aureus (44.3%), followed by Escherichia coli (25.7%) and Pseudomonas aeruginosa (16.9%). Methicillin-resistant S aureus (MRSA) was found in 2.7%. The most prescribed antibiotic was ceftriaxone. One hundred thirty-five patients (91.8%) were cured only with the use of antibiotics. There was a statistically significant increase in infection by bomb blast injuries compared with SSI (P G0.0001), whereas no significant correlation was present between SSI and type of fracture, extremity involvement, sex, or surgical procedure. Conclusion: The incidence of surgical site infection is high in gunshot injuries and bomb blast injuries. Staphylococcus aureus was found to be the most common etiological agent, whereas MRSA comprised a very low percentage of infections. Polymicrobial infections were rare. Initial thorough debridement and antibiotics are the mainstay of treatment. Study Level: Prospective cohort (level II)