Association of Osteoporosis with Antibiotic Resistance among Postmenopausal Women with Open Tibial Fractures

Osteoporosis is common among postmenopausal women and can complicate the healing of open tibial fractures. Antibiotic resistance is a growing concern in treatment. Yet, the connection between osteoporosis and antibiotic resistance remains unclear, needing the investigation for improved patient care. Objective: To explore the association between osteoporosis and antibiotic resistance among postmenopausal female patients with open tibial fractures. Methods: This cross-sectional study was conducted at Department of Orthopedic Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, with sample size of 240 postmenopausal women with open tibial fractures and signs of infection within one week of the fracture. Participants were chosen via non-probability sampling method. Bacteriological samples for culture were obtained from secretions adjacent to the infected tissue. Data analysis was conducted using SPSS version 21.0. Results: The majority of osteoporotic patients experienced Road Tra�c Accidents (RTA) (42.5%), followed by falls from height (35.3%), while �rearm injuries were less common (22.2%). Staphylococcus aureus was the most common pathogen in both osteoporotic (40%) and non-osteoporotic (39.9%) patients, followed by Escherichia coli, Methicillin-Resistant Staphylococcus Aureus (MRSA), Klebsiella, and Pseudomonas aeruginosa. Antibiotic resistance was predominantly found against S. aureus, MRSA, Klebsiella and E. coli. Co-Trimoxazole exhibited the highest resistance rates across all four bacterial organisms, ranging from 34% to 50%. Conclusions: The study found varying antibiotic resistance patterns across various pathogens, with notable resistance observed MRSA strains. Antibiotic resistance was observed in osteoporotic group, with Co-Trimoxazole showing the highest resistance rates.

wo m e n a r e e s p e c i a l l y v u l n e r a b l e to i t s s eve r e consequences, such as osteoporotic fractures [10].
Research indicates that nearly one-third (33%) of women over 50 years old have a likelihood of experiencing osteoporotic fractures [11].Estrogen levels have a positive correlation with Bone Mineral Density (BMD) and play a protective role against osteoporotic fractures [12].This association may be explained by the direct effects of estrogen on bone cells, including osteoblasts, osteocytes, and osteoclasts, which contribute to maintaining a balance between bone formation and resorption [13].Weakening of bones increases the risk of open fractures, particularly in the extremities.Previous research has highlighted the high contamination rates observed in open tibial fractures, which can result in delayed wound healing and treatment failure.Prompt administration of antibiotic prophylaxis following injur y, along with urgent and thorough débridement, irrigation, and bony stabilization, is crucial to minimize the risk of infection and enhance outcomes [14].Despite the established standard of care recommending timely irrigation and debridement within six hours postinjury for managing open tibial fractures, current evidence does not uniformly support this practice, and uncertainties persist regarding the ideal irrigation solution and pressure [15].Information about which germs are usually found in hospitals and how they needs to be responded to antibiotics is important for giving patients the right treatment [14].Doctors choose the right antibiotics and how long to use them based on factors like the kind of broken bone, how the injury happened, where it is, the results of tests to see which germs are present, and what kinds of germs are causing the infection.The primary goal of antimicrobial therapy is to safeguard clean tissue from infection and reduce the number of contaminating bacteria in damaged tissue until surgical irrigation and debridement can be performed [16].However, there is a lack of clear evidence regarding the speci c causative organisms and their sensitivity patterns in postmenopausal women with osteoporosis, necessitating further investigation.The aim of this study was to explore the association between osteoporosis and antibiotic resistance among postmenopausal female patients with open tibial fractures, presenting at the Department of Orthopedic Surgery, Liaquat University of Medical and Health Sciences, Jamshoro.This study was conducted to assess the empathy scores among medical and dental students and to correlate empathy scores with demographic features like age, gender and academic year.

R E S U L T S
The study comprised 240 female patients with open tibial fractures with a mean age of 52.98 ± 6.479 years.(63.75%) women were diagnosed with osteoporosis, while 87 (36.25%) did not show any sign of osteoporosis (Figure : 1).The duration of fracture was recorded to be 10.76 ± 3.151 hours on average, while the time from injury to the collection of culture swabs was found to be 5.9 ± 1.27 hours.
Health Sciences, Jamshoro.A sample size of 240 cases was determined with a 90% con dence interval and a 5% margin of error, taking the prevalence of osteoporosis in postmenopausal women as 33% [11].Non-probability c o n s e c u t i v e s a m p l i n g w a s u t i l i z e d t o s e l e c t postmenopausal women with and presenting with open tibial fractures and signs of infection within one week of the fracture.Osteoporosis was diagnosed via Bone Mineral Density Method (BMD).Exclusion criteria encompassed patients presenting after seven days of the fracture, those receiving antibiotics for infection before or after the accident, women having diabetes with blood sugar levels exceeding 186mg/dl, and cases of open tibial fractures categorized as Gustilo type III C. The study lasted 1 year from Feb 2017 to Jan 2018.After obtaining informed consent, demographic information, histor y and examination of the patients along with assessment of w o u n d c o n d i t i o n w a s d o n e .R a d i o l o g i c a l a n d microbiological investigations were per formed.Bacteriological samples were obtained from secretions adjacent to the infected tissue using sterile cotton swabs and disposable syringes, which were promptly transferred to the microbiology laboratory for incubation at 37°C for hours to enrich bacterial cells.Gram staining and acid-fast staining were performed on all samples, followed by sub culturing for aerobics.Isolates were identi ed using standard microbiological procedures and tested for antimicrobial susceptibilities via the Kirby Bauer method in accordance with Institutional Laboratory guidelines.Sensitivity patterns were determined for detected causative organisms.Data analysis was conducted using SPSS version 21.0, presenting main study variables such as causative bacterial organisms and their sensitivities in terms of frequency, percentage, and strati cation for effect modi ers like, type of fracture prior to arrival at Liaquat University Hospital.Chi-square test was applied to assess associations among variables.

Osteoporosis and Antibiotics in Postmenopausal Women
A cross-sectional study was conducted at Department of Orthopedic Surgery, Liaquat University of Medical and In table 1, regarding the mode of injury, the majority of osteoporotic patients experienced Road Tra c Accidents (RTA) (42.5%), followed by falls from height (35.3%), while rearm injuries were less common (22.2%).Conversely, non-osteoporotic patients had a higher incidence of RTA (51.7%) and falls from height (39.1%), with rearm injuries being relatively rare (9.2%).Regarding the type of fracture, osteoporotic patients predominantly presented with Type III A fractures (53.6%), whereas Type III B fractures were more prevalent among non-osteoporotic patients (70.1%).These ndings suggest a potential association between osteoporosis and the severity or mechanism of injury in patients with open tibial fractures.In table 2, the frequency of causative bacterial organisms varied between the two groups.Staphylococcus aureus (S. aureus) was the most common pathogen in both osteoporotic (40%) and non-osteoporotic (39.9%) patients, followed by Escherichia coli (E.coli), Methicillinresistant Staphylococcus aureus (MRSA), Klebsiella, and Pseudomonas aeruginosa (P.aeruginosa).Interestingly, while the overall distribution of bacterial organisms was similar between the two groups, there were slight variations in the percentages, indicating potential differences in susceptibility or exposure to speci c pathogens among osteoporotic and non-osteoporotic patients.

Table 1 :
Mode of Injury and Type of Fracture among Patients with Open Tibial Fractures

Table 2 :
Frequency of Various Causative Bacterial Organisms among Patients with Open Tibial Fractures