Bacterial Contamination of Fresh Traumatic Wounds at Trauma Center, Siriraj Hospital, Bangkok, Thailand
Rujipas Sirijatuphat MD*, Preecha Siritongtaworn MD**, Vipaporn Sripojtham RN***, Adhiratha Boonyasiri MD*, Visanu Thamlikitkul MD*
Affiliation : * Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand *** Department of Nursing, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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.
Keywords : Traumatic wound, Bacterial contamination, Anti-biotic prophylaxis
