Management of infected wounds of open fracture with vacuum sealing drainage and traditional dressing change: a bacteriological comparison

Abstract

Objective To compare the bacteriological changes at the infected wounds of open fracture after management with vacuum sealing drainage (VSD) and traditional dressing change.Methods We retrospectively reviewed the 121 patients who had been treated for open fractures at our institute but inflicted with wound infection after emergency surgery from October 2010 to July 2013.They were 88 males and 33 females,aged from 4 to 75 years (average,39.9 years).The interval from injury to admission ranged from 1 to 16 hours (average,6.0 hours).They underwent internal or external fixation or amputation after emergent debridement.They were divided into 2 groups according to the wounds management following emergency surgery.In group A where VSD was used for management of the wounds,there were 45 males and 15 females,with an average age of 40.6 ± 17.0 years.In group B where traditional dressing change was used,there were 43 males and 18 females,with an average age of 37.3 ± 13.4 years.Culture results of strains and drug sensitivity of the bacteria sampled from the infected wound were compared between the 2 groups.Results In group A of 60 patients,60 strains of 8 kinds were isolated; in group B of 61 patients,69 strains of 11 kinds were isolated.The majority of pathogenic bacteria in the 2 groups were gram-negative bacteria [83.3％ (50/60) in group A versus 91.3％ (63/69) in group B].Acinetobacter baumannii was the main pathogenic bacteria [36.7％ (22/60) in group A versus 49.3％ (34/69) in group B].The infection rate of multi-drug resistant bacteria (MDR) was 20.0％ (12/60) in group A and 60.9％ (42/69) in group B,with a significant statistical difference between the 2 groups (P ＜ 0.05).Acinetobacter baumannii still accounted for a chief proportion of MDR [83.3％ (10/12) in group A versus 81.0％ (34/42) in group B].The drug resistance of Acinetobacter baumannii to cefoperazone sulbactam was 9.1％ in group A (2/22) and 44.1％ in group B (15/34),with a significant statistical difference between the 2 groups (P ＜ 0.05).Conclusions The majority of pathogenic bacteria for open fractures are gram-negative bacteria.VSD may significantly reduce the infection rate of MDR in open fractures. Key words: Fractures, open; Bacterial infections; Gram-negative bacteria; Drainage