Pathogens and Shift of Resistance in Early Infections after Operative Fracture Fixation

Oberhuber-Kurth, Lisa Maria; Angeli, Rico; Lippmann, Norman; Notov, Dmitry; Osterhoff, Georg; Frank, Konstantin; Langer, Stefan und Kohler, Lukas (2022): Pathogens and Shift of Resistance in Early Infections after Operative Fracture Fixation. In: Surgical Infections, Bd. 23, Nr. 6: S. 583-589

Abstract

Background: Surgical site infections (SSIs) remain a challenge for the healthcare system. During the last 30 years, the literature has shown an increase of gram-negative bacterial strains in multiple infectious sites and that cephalosporins have replaced penicillin as the gold standard in peri-operative antibiotic prophylaxis. This study aims to examine the recent bacterial spectrum in orthopedic early SSIs and to compare it with a historical cohort.Patients and Methods: Patients in a level 1 trauma center with an SSI within six weeks after open fixation of a fracture were analyzed in two adjacent periods from 2007 to 2012 (data pool 1;DP1) and 2013 to 2017 (data pool 2;DP2), retrospectively. The detected microbiologic pathogens and the associated resistograms from both time periods were compared.Results: Six hundred eighty-one smear tests and respective pathogens from the wounds of 463 patients (mean age, 62.6 +/- 20 years) with SSIs were analyzed. The following pathogens were found most frequent: Staphylococcus epidermidis (DP1, 20.6%;DP2, 26.3%), Staphylococcus aureus (DP1, 27.1%;DP2, 16.5%), Enterococcus faecalis (DP1, 13.7%;DP2, 11.1%), Bacillus sp. (DP1, 3.0%;DP2, 5.3%), Escherichia coli (DP1, 5.1%;DP2, 4.1%), Pseudomonas aeruginosa (DP1, 3.7%;DP2, 2.5%). In DP2, there were lower primary early infection rates with Staphylococcus aureus than in DP1 (p = 0.002). In DP2, Staphylococcus epidermidis showed an oxacillin resistance in 90.6% and an increased resistance (79.8%;p = 0.069) to several classes of antibiotic agents compared to DP1.Conclusions: No bacterial shift toward gram-negative species was observed in this investigation. However, Staphylococcus epidermidis showed an increased antibiotic resistance in the more recent patient cohort. The incidence of SSIs with Staphylococcus aureus decreased substantially.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1096-2964
• Sprache: Englisch