Introduction: The dynamics of bacterial populations in soft tissue wounds and bone differ greatly over time. The primary goal in the management of open fracture is the prevention of the infection of the bone and soft tissue. To achieve this goal, the most widely accepted treatment protocols include early surgical debridement, irrigation of open wounds, administration of broad- spectrum antibiotics, and stabilization of fractures.In this study, we studied the pattern of bacterial isolates in all cases of open fractures of extremities that came to the local secondary \& tertiary care hospitals.
Material and Methods: This Cross Sectional analytical study involved Prior Consent from the patients \& was found to be within ethical standards. It was conducted in nine months. In the present study, 100 patients of all ages, both the sexes, with open fracture of all the grades as per Gustilo-Anderson classification, coming to Orthopaedic Outpatient Department and Emergency Dept of selected hospitals including ours were selected.
Results: Patients who were brought after 6 h showed maximum growth of bacterial isolates. Pre-debridement cultures were taken in all 100 patients, and the presence of growth of organism was found in 56% . Out of the positive 56 patients, 37 (66%) were found to have Gram-positive bacterial growth. Coagulase-negative \textit{Staphylococcus aureus} was the most common Gram- positive bacteria isolated. Gram-negative bacteria were found in 19 (34%) cases, which showed different isolates occurring in same number.Post-debridement cultures showed growth in 34% patients with no growth in rest patients [Table 2]. Out of the 34 patients, Gram-positive bacteria were isolated in 18 patients and Gram-negative in rest 50%. Coagulase-negative S. aureus was the most common.
Conclusion: Predebridement cultures are of no importance in treating open fractures. Postdebridement cultures are important in formulating an antibiotic policy to be started in patients of open fractures as soon as possible. Gram-negative organisms are the most probable cause of infection in cases of open fracture. Our antibiotic policy should cover both Gram-positive and Gram-negative organisms with two antibiotic drug regimen if possible. Aminoglycosides are the most sensitive group of drugs in both Gram- positive and Gram-negative bacteria.
