Role of Microbial Pathogens in Delayed Healing of Orthopaedic Surgical Wounds

Hafiz Shoaib Muhammad; Dua  Noor Baig

doi:10.54112/bcsrj.v6i1.2109

Authors

Hafiz Shoaib Muhammad Department of Internal Medicine, RHC Qadir Abad/Nishtar Hospital, Multan, Pakistan
Dua Noor Baig Department of Microbiologist, Quaid-I-Azam University Islamabad, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i1.2109

Keywords:

Surgical Wound Infection, Orthopaedic Procedures, Wound Healing, Drug Resistance, Bacterial, Staphylococcus aureus.

Abstract

Delayed healing of orthopaedic surgical wounds is a major postoperative concern, particularly when wounds are complicated by microbial contamination, biofilm formation, and multidrug-resistant organisms. In orthopaedic patients, infection may prolong inflammation, impair epithelialization, increase hospital stay, and lead to repeated surgical intervention. Objective: To determine the role of microbial pathogens in delayed healing of orthopaedic surgical wounds and to identify clinical and microbiological predictors associated with poor wound recovery. Methods: This prospective observational study was conducted at the Department of Orthopaedic Surgery of a tertiary care hospital from January to June 2024 A total of 70 adult patients undergoing orthopaedic surgical procedures were enrolled through non-probability consecutive sampling. Demographic, clinical, operative, wound-related, and microbiological data were recorded. Wound samples from clinically suspected infected wounds were processed for Gram staining, culture, organism identification, and antimicrobial susceptibility testing. Delayed healing was defined as persistent discharge, wound breakdown, delayed epithelialization, or need for additional wound intervention beyond postoperative day 14. Data were analyzed using SPSS version 26, and a p-value <0.05 was considered statistically significant. Results: The mean age of patients was 43.6 ± 15.2 years, and 46 patients (65.7%) were male. Delayed wound healing was observed in 26 patients (37.1%). Culture-positive wounds were identified in 38 patients (54.3%), while multidrug-resistant organisms were isolated in 18 patients (25.7%). Culture positivity was significantly higher among delayed-healing wounds than timely-healing wounds (88.5% vs. 34.1%, p<0.001). Multidrug-resistant organisms were also more frequent in delayed-healing wounds (57.7% vs. 6.8%, p<0.001). Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii were the major isolates. On multivariable logistic regression, culture-positive wound status, multidrug-resistant organism isolation, open fracture, and procedure duration greater than two hours remained independent predictors of delayed wound healing. Conclusion: Microbial pathogens, particularly culture-positive wounds and multidrug-resistant organisms, were strongly associated with delayed healing of orthopaedic surgical wounds. Early culture-based diagnosis, timely antibiotic prophylaxis, strict infection-control practices, and antimicrobial stewardship may reduce delayed healing, wound complications, and the need for repeat surgical intervention.

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