Patterns and Predictors of Delayed Antibiotic Administration in Open Fracture Care at CHUK

Authors:
Emile Musoni, Isabella Hung

Body of Abstract:
Background: Open fractures are among the most common cases received at emergency departments (ED) in low- and middle-income countries and early administration (within 60 minutes) of antibiotics is the cornerstone component in the management of open fractures. We aim to evaluate the risk factors associated with delays in time to antibiotics administration for patients with long bone open fractures at the University Teaching hospital of Kigali (CHUK) in Rwanda.

Methods: This is a prospective study of all ages presenting to the emergency department of CHUK with an open long bone fracture. Those admitted from other health facilities or presented with infected wounds were excluded. Participants completed a structured questionnaire. Data were collected between December 2020 to April 2022 and analyzed using Stata version 13. Binary logistic regression was used to determine risk factors in >60 minutes antibiotic administration.

Results: A total of 120 participants were recruited, the majority were males (N= 100, 83.3[MSD2] %). 99.17% (N= 99) of participants presented to the emergency department >1 hour after their accident. Additionally, 42.5% (N= 51) of participants received antibiotics within the first 60 minutes. Nightshift admissions had 6 times the odds of receiving antibiotics after 60 minutes as compared to dayshift (OR=6.0, 95% CI: 2.58-13.93, p<0.001). Patients without medical insurance had 8.5 times the odds of receiving antibiotics after 60 minutes as compared to those with health insurance (OR=8.5, 95% CI: 1.04-58.51, p=0.045) and children who presented at the emergency department with open fractures had 3.8 times the odds of receiving antibiotics after 60 minutes compared to adults (OR=3.8, 95% CI: 1.02-14.07, p=0.031). Conclusion: Delays in antibiotic administration were widespread amongst patients presenting to CHUK with open long bone fractures. Patients particularly at risk included pediatric patients, patients without health insurance, and those presenting overnight. Furthermore, delays in presentation resulted in nearly all patients receiving antibiotics greater than 60 minutes from time of injury. Providing antibiotics in the prehospital setting may help reduce these delays. Additionally, targeted educational programs for providers may help prevent delays in antibiotic administration after arrival.