A clinicobacteriological study on wound infection in patients with oral and maxillofacial trauma

Seo, Il Young; Ryu, Seung Hee; Ryu, Sun Youl

Abstract

With increasing incidence of motor vehicle accidents and violent instrument-aided assaults, there has been a concomitant increase in oral and maxillofacial injuries. One of the greatest problems in achieving successful treatment for the injuries is wound infection. This study is to use selected antibiotics appropriately from bacteriological culture and antibiotic sensitive test for curing of wound and to prevent the infection by microorganism and also to prevent misusing and abusing antibiotics. A clinicobacteriological study was done in 40 patients with maxillofacial injuries treated in the Department of Oral and Maxillofacial Surgery of Chonnam University Hospital during the period of March 2002 though August 2002. Causative bacteria of wound contamination and infection were identified by bacteriological culture. Antibiotic sensitivity test was also done for the isolated bacteria. Clinical data were analyzed for the following issues: sex and age distribution, causes, types, site of injuries, and time elapsed from injury to treatment. Bacterial culture was positive in 29 out of 40 cases: 16 out of 20 fracture and laceration wounds, and 13 out of 20 simple laceration wounds. Frequently isolated bacteria were Streptococci viridans (24%), grampositive bacilli (24%), Streptococcus salivalius (13%), and Staphylococcus species(13%). Streptococcus species were the most popular bacteria in the oral cavity(44.8%) and Staphylococcus species on the facial skin (27.3%). In comparison, Streptococcus species were the most popular bacteria in the oral cavity (41%) and Staphylococcus species the facial skin (53.6%) in normal healthy subjects. The positivity of bacterial culture was not related with causes of injury, ages, or sexes, but closely related with types and locations of the injuries and time intervals from injury to treatment. The injuries in the oral cavity (75.8%) were more positive in the bacterial culture than facial skin injury (63.6%) and complex lacerations (80%) were more positive in the bacterial culture than simple lacerations (65%). The patients who had a treatment from injury over 3 hours showed more positivity in the bacterial culture than those under 3 hours. The isolated bacteria were more sensitive to clindamycin, erythromycin, cefotaxim than to oxacillin, ampicillin and penicillin. In conclusion, effective antibiotics should be given judiciously in patients who have severe oral and maxillofacial trauma, who do not have proper treatment for hours, and who have simple injuries in oral cavity as well. Clindamycin, erythromycin, cefotaxim are effective as primary antibiotics in these cases.