Sim, Chua Boon
(2021)
Comparison of the efficacy of intravenous oxycodone versus morphine on postoperative pain following orthopaedics surgery under general anaesthesia.
Masters thesis, Universiti Sains Malaysia.
Abstract
The devastating outcome of orthopaedic surgical site infections (SSI) are largely preventable
if its risk factors, causative organisms and antimicrobial susceptibility patterns in the regional
area are known. We conducted a retrospective study to address the lack of epidemiological
and microbiological data on orthopaedic SSI in Malaysia. All the 80 patients diagnosed and
treated for microbiologically proven orthopaedic SSIs in a tertiary hospital in Malaysia from
April 2015 to March 2019 were included in a 1:2 case control study. The prevalence of SSI in
clean and clean-contaminated surgeries was 1.243%, which is consistent with most of the
studies worldwide, but is low compared to other studies done in Malaysia. The most common
type of orthopaedics SSI was internal fixation infections (46.25%). Obesity and tobacco use
were found to be significant risk factors of orthopaedic SSI. The most common perioperative
prophylaxis used was IV cefuroxime. Majority of the cases (86.5%) received prolonged
prophylactic antibiotics. The most common causative agent was Staphylococcus aureus
(31.25%), followed by Pseudomonas aeruginosa (26.25%) and Enterobacter spp (7.5%).
Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 20% of the S. aureus
infections. Up to 19.4% of the Gram negative organisms are multidrug resistant. The
prevention of SSI in orthopaedic practice, its prevalence and trends in microbiological profile
are related to the management of the risk factors, the appropriate use of prophylactic
antibiotics and implementation of infection control measures. A more definitive and larger
study in the country is needed to address these issues. We also investigated the role of
stingless bee honey as a potential topical agent for the treatment of orthopaedic SSI, to take
advantage of its anti-bacterial and anti-biofilm properties. In-vitro synergistic testing was
conducted to test honey-antibiotic combinations against MDR Gram Negative and Gram
positive organisms. At 5% concentration, stingless bee honey can be safely used as an
adjunctive topical agent, without any antagonistic effect with systemic antibiotics
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