Time to Prophylactic Antibiotics Administration to Patients with Long Bone Open Fractures from Arrival to The Emergency Department of Kigali University Teaching Hospital

Abstract

Background: Open fractures are among the most common cases received at emergency departments worldwide and early administration of antibiotics is the cornerstone component in the management of open fractures. The aim of this study is to evaluate the time of antibiotics administration to patients with long bone open fractures and factors associated with delayed prophylactic antibiotics administration. Methods: This was a prospective cross-sectional study that was conducted at the Emergency department of KUTH. The study used consecutive sampling and included 120 participants. Data were collected using a structured questionnaire and the collected data were entered into Epidata version 3.1 then exported to Stata version 13 for analysis. Chi-square test and binary logistic regression were used to study the relationship between early or late antibiotics administration and possible predictors. Statistical significance for associations was taken at the level p < 0.05. Results: The median age was 31 years with 47.9% of the patients being aged between 16 and 35 years. Most of the patients who presented with open fractures were male (83. 3%).Most patients (80.0%) who presented with open fractures received ceftriaxone, while 44.17% received gentamycin. Most of patients (55.0%) had tibia and/or fibula open fractures followed by femur fractures at 14.2%. Patients with long open fractures who presented during night were 6 times more likely to receive antibiotics after 60 minutes as those who presented during the day (OR=6.0, 95% CI: 2.58-13.93, p<0.001). Patients without medical insurance were 8.47 times more likely to receive antibiotics after 60 minutes as those who have health insurance (OR=8.47, 95% CI: 1.04-58.51, p=0.045) and children who presented at the emergency department with open fractures were 3.7 times more likely to receive antibiotics after 60 minutes as adults (OR=3.78, 95% CI: 1.02-14.07, p=0.031). Conclusion: Patients who present to the emergency department of KUTH with open long bone fractures receive the antibiotics within a median time of 44 minutes from the time of arrival. One patient presented within one hour after injury (golden hour). Forty-two percent of the total patients received antibiotics within the first 60 minutes of their presentation to the emergency department. Younger age, absence of health insurance and presenting at A&E during night shift were significantly associated with receiving antibiotics after 60 minutes of arrival