Background: The pattern of organisms found in open fractures is important in the selection of antibiotics for prophylaxis and empirical treatment. So far, there is paucity of data on local patterns of bacteria contaminating and infecting open fractures and their antibiotic susceptibility profile. Objective: To describe the pattern and antibiotic susceptibility of bacterial isolates obtained within 24 hours of injury from open fractures and to compare these to bacterial isolates from fractures that subsequently develop infection. Methods:A prospective study of 98 patients with open fractures seen at Kenyatta National Hospital (KNH) within 24 hours of injury between November 2015 and March 2016 was conducted. Swabs for culture and sensitivity were taken from the wounds and antibiotics initiated.Surgical debridement was subsequently carried out witha 14 day follow up for wound infection. Wounds thatbecame infected were sampled for cultures And sensitivity. Results: Fifty-one (52.2%) pre debridement wound samples had positive cultures. Staphylococcus aureus and (Coagulase Negative) CON Staphylococci were the predominant gram positive isolates. At 14 days' follow-up, the infection rate was58.9 %. The predominant gram positive isolate was Staphylococcus aureus. Only 5.7% of the predebridement isolates were similar to the post debridement isolates. Conclusions: The contaminating organisms are not similar to the organisms isolated from injuries that later develop infection.
Tertiary hospitals in resource-limited countries treat patients referred but in most cases are the first level of care for the vast majority of patients. As a result, the tertiary facility effectively functions as a primary health care facility. The urban phenomenon of widespread self-referral is associated with low rates of formal referral from peripheral health facilities. Study Objective: To determine the patterns of orthopaedic and trauma admissions to Kenyatta National Hospital. Methodology: This was descriptive study design. Sample size was 905 patient charts for 2021 Findings The mean age was 33.8 years (SD 16.5) with range of 1 - 93 years. Majority 66.3% were between 25 – 64 years with those above 65 years being 40 (4.4%). Children 0-14 years comprised 10.9% of the admissions. Of the 905 admissions, 80.7% were accident and trauma-related admissions while 17.1% were non-trauma related admissions. About 50.1% were facility referrals while 49.9% were walk-ins. Majority of admissions were through Accident and Emergency Department 78.1%, Corporate Outpatient Care 14.9% and Clinic 7.0%. About 78.7% were emergency admissions while 20.8% were elective admissions. Approximately admissions 48.5% were due to Road Traffic Accidents, 20.9% due to falls and non-trauma related conditions represented 17.1%. Close to 44.8% were casual workers and 20.2% unemployed. Education level was also reviewed with 34.0% having primary education and 35.0% having secondary education. A significant proportion of female admissions (33.2%) were due to non-trauma conditions as compared to male admissions (12.8%) (p<0.001). Aadmissions for those aged 25 – 64 years were 3.5 more likely to have emergency admission as compared to those aged 0 – 14 years. Male were 65.1% less likely to have elective admissions compared to female (p<0.001). Those unemployed were 3.9 more likely to have emergency admission compared to businessmen/women. Vast majority (89.2%) of admissions were within Nairobi Metropolitan region
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