Bacterial contamination of fresh traumatic wounds at Trauma Center, Siriraj Hospital, Bangkok, Thailand

Abstract

Background: Fresh traumatic wound is a common health problem in patients attending Trauma Center at Siriraj Hospital in Bangkok, Thailand. Antibiotic prophylaxis was given to nearly 90% of such patients. A contributing factor to a high prevalence of antibiotic prophylaxis is a lack of data on bacterial contamination at fresh traumatic wounds in Thai patients. Objective: To determine prevalence and characters of bacterial contamination, and incidence of wound infection in adult patients with fresh traumatic wounds attending Siriraj Trauma Center. Material and Method: Prospective study was conducted in 330 adult patients with fresh traumatic wounds from March 2012 and September 2012. All patients received wound care and antibiotic prophylaxis according to the judgment of their responsible physicians. A wound swab culture was taken from all patients. The patients were either called by telephone or asked to have follow-up visits in order to determine incidence of wound infection. The infected patient received regular care. Results: Sixty-three percent and 8% of the patients had lacerated wounds and bite wounds, respectively. Ninety-one percent of them received antibiotics of which dicloxacillin and co-amoxiclav accounted for 80.3% and 11.4%, respectively. Wound swab cultures revealed that potential pathogenic bacteria i.e. S. aureus, streptococci, Enterobacteriaceae, Aeromonas spp., Acinetobacter spp. and non-fermentative gram-negative rods (NF GNR) were recovered from 7% of wounds. Incidence of wound infection was 1.2%, and all infected wounds were found in patients who had a contaminated wound and received antibiotic prophylaxis. Bacterial contaminations of infected patients were NF GNR, E. cloacae, and mixed organisms. All wound infections were successfully treated with appropriate wound care. Conclusion: More than 90% of adult patients with fresh traumatic wound at Siriraj Trauma Center received prophylactic antibiotics. Less than 10% of these wounds were contaminated with potentially pathogenic bacteria. Incidence of wound infection in fresh traumatic wounds was low.