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Development of the Bacterial Spectrum and Antimicrobial Resistance in Surgical Site Infections of Trauma Patients.
- Source :
-
Surgical infections [Surg Infect (Larchmt)] 2020 Oct; Vol. 21 (8), pp. 684-693. Date of Electronic Publication: 2020 Jan 16. - Publication Year :
- 2020
-
Abstract
- Background: While ubiquitously multi-resistant bacteria are on the rise, peri-operative antimicrobial prophylaxis in trauma and near-to-bone surgical procedures has only been changed slightly during the last 25 years. Recent clinical studies concerning the bacterial spectrum and efficacy of antimicrobial treatment in infected trauma surgical patients are rare. The aim of the study was analysis of the contemporary bacterial spectrum and its antimicrobial resistance including the assessment of the appropriateness of peri-operative antimicrobial prophylaxis with cefuroxime. Methods: Patients of a level-I academic trauma center who underwent open or arthroscopic surgery because of a recent trauma necessitating the use of bone-near metal implants were included in the study. All patients in whom a surgical site infection (SSI) had developed during six weeks post-operatively necessitating surgical debridement and had positive microbiologic culture results from an intra-operative surgical site swab were analyzed, retrospectively. In particular, age, gender, date and duration of surgical interventions, and patient's related risk factors were collected, and infecting agents and their minimum inhibitory concentration values for 34 selected antimicrobial agents were evaluated. An SSI occurring later than 6 weeks post-operatively and patients with chronic and septic wounds were excluded. Statistical analysis was performed with SPSS <superscript>®</superscript> (IBM, Armonk, NY). Results: There were 438 pathogens cultured in specimens from 303 enrolled patients (female = 140, male = 163). The most frequent pathogens were Staphylococcus aureus (27.1%), S. epidermidis (20.6%), Enterococcus faecalis (13.6%), Escherichia coli (5.1%), and Pseudomonas aeruginosa (3.7%) accounting for 303 isolates. Of those, 89 (29.4%) were multi-resistant. Of the S. epidermidis isolates, 79.8% (n = 71) were resistant against Oxacillin and thus against most beta-lactam antibiotic agents. Altogether, only 44.1% of the infecting organisms were susceptible to cefuroxime, the antimicrobial agent most often being used for prophylactic purposes. Conclusion: Standardized antimicrobial prophylaxis with cephalosporins has to be reconsidered critically. Multi-resistant species such as S. epidermidis are an increasing challenge in trauma operations.
- Subjects :
- Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Anti-Bacterial Agents administration & dosage
Antibiotic Prophylaxis methods
Drug Resistance, Multiple, Bacterial
Female
Humans
Male
Middle Aged
Operative Time
Retrospective Studies
Risk Factors
Sex Factors
Young Adult
Anti-Bacterial Agents pharmacology
Arthroscopy adverse effects
Drug Resistance, Bacterial
Surgical Wound Infection microbiology
Wounds and Injuries surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1557-8674
- Volume :
- 21
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Surgical infections
- Publication Type :
- Academic Journal
- Accession number :
- 31944899
- Full Text :
- https://doi.org/10.1089/sur.2019.158