Frequency and Antimicrobial Susceptibility Pattern of Methicillin Resistant Staphylococcus Aureus in Open Fractures INTRODUCTION: Open fracture or compound fracture is one in which there is overlying soft tissue wound in the skin 1 Department of Orthopaedics & Traumatology Unit A Medical Teaching Institution Lady Reading Hospital Peshawar 2 Department of Orthopaedics Saidu Medical College Swat KPK Correspondence: Dr. Faaiz Ali Shah 1 * Department of Orthopaedics & Traumatology Unit A Medical Teaching Institution Lady Reading Hospital Peshawar Email: faaizalishah@yahoo.com communicating it to the outside environment. 1 High energy trauma due to motor vehicle accidents, gunshot injuries, fall from height and industrial or occupational injuries, is the usual cause of open fractures. 2,3 Open fractures constitute 3-4% of all the fractures. 4 It has been reported that approximately seventy percent of all open fractures are contaminated at the time of initial injury. 5 Gustilo- Anderson classification is most commonly used to categorize open fractures. 6 The usual bacterial pathogens isolated from open fractures are methicillin-sensitive Staphylococcus aureus (23% to 35%). 7,8 Other organisms are coagulase negative staphylococcus aureus (11%) and gram negative pathogens (31% to 48%). 7,9 Methicillin resistant ABSTRACT Objective Study design Descriptive case series. Place & Duration of study Methodology Key words Conclusions Results Orthopaedics & Traumatology Unit A Lady Reading Hospital Peshawar, from January 2014 to June 2016. Methicillin resistant staphylococcus aureus infection in open fracture wound is not uncommon. The isolated pathogen showed a variable pattern of sensitivity and resistance to the antibiotics tested. Patients of both gender and all ages fulfilling the inclusion criteria were included in this study. Swabs were taken from wounds with Levine’s technique and sent to the hospital laboratory immediately where standard methodology was adopted for culture and sensitivity of the pathogens in all cases and results were reported as per Clinical and Laboratory Standards Institute (CLSI) guidelines. All MRSA positive cases were isolated within 24 hours and the standard MRSA protocol implemented immediately. A total of 200 open fractures were sampled over a period of two and a half years. Positive cultures of MRSA were obtained in 47(23.5%) patients. The mean age of the patient was 24 year ( range 18 year to 52 year). Males were 43(81.4%) while females 4(8.5%) in number. Open tibial fractures were highest (n=21, 44.6%) in number followed by femur (n=12, 25.5%). Majority (n=15, 31%) of the fractures were Type IIIA. All of the isolated MRSA cultures were 100% sensitive to vancomycin, linezolid, teicoplanin, chloramphenicol and tigecycline while resistance was observed for ciprofloxacin, levofloxacin, clarithromycin, and erythromycin. Faaiz Ali Shah, 1 * Shahab Ud Din, 1 Waqar Alam 2 Wali Mohammad Khan 1 62 Open fracture, Methicillin resistant staphylococcus aureus, Antimicrobial therapy. ORIGINAL ARTICLE OPEN ACCESS Journal of Surgery Pakistan (International) 21 (2) April - June 2016 To determine the frequency and antibiotic sensitivity of methicillin resistant staphylococcus aureus (MRSA) in open fractures.