Speakers - 2026

Title: Predictors of Delayed Antibiotic Administration in Open Fracture Care in Rwanda

Abstract

Background: Open fractures are among the most common cases received at emergency departments (ED) in LMICs and early administration of antibiotics is pivotal to reduce the risk of infection. This study aimed to evaluate 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 was a prospective study of all ages presenting to the ED with an open long bone fracture. Those admitted from other health facilities or presented with infected wounds were excluded. Participants completed a questionnaire and data were collected between December 2020 to April 2022 the 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, most were males (N= 100, 83.3%). Most patients (N=99, 99.17%) presented to the ED >1 hour after their injury. 42.5% (N= 51) of participants received antibiotics within the first 60 minutes. Nightshift arrival 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 pediatric patients 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 study participants. Those 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 these delays.