Retrospective study on the etiological spectrum and antibiotic resistance in infections associated with osteosynthesis materials

Rev Med Chir Soc Med Nat Iasi. 2014 Jan-Mar;118(1):147-53.

Abstract

Aim: To determine the prevalence of infections according to their etiologic spectrum and antibiotic sensitivity in patients with or without implants and endoprostheses.

Material and methods: This retrospective study was conducted based on a customized study protocol on 773 cases admitted to the Clinic of Orthopedics - Traumatology of the Iaşi "Sf. Spiridon" Emergency Hospital in the interval January 1, 2003 - December 31, 2011 for postoperative infectious complication.

Results: S. aureus was more frequently found in the patients without implant (58.2%) and in those with subcutaneous implant (45.5%); the lowest frequency was noticed in the patients with endoprosthesis (27.1%), the frequency distributions showing marked statistically significant differences (p = 0.001). P. aeruginosa was more frequently detected in the patient group with endoprosthesis (30.2%), while in the other groups it was found in approximately 7% (p = 0.001). The presence of Acinetobacter spp. was significantly higher in patients with deep implant (12.9%), with the lowest frequency noticed in the patients without implant (4.5%) (p = 0.029). Of the total isolated and identified types, 59.6% were non-multidrug-resistant (non-MDR), the remaining 40.4% being MDR types.

Conclusions: S. aureus was the most frequent etiological agent in patients with or without cutaneous implant (45.5 and 58.2%, respectively), and P. aeruginosa (30.2%) in the endoprosthesized patients. Implementation of a preoperative screening protocol for the identification of healthy S. aureus carriers (Methicillin-sensitive S. aureus - MSSA/Methicillin-resistant S. aureus - MRSA) and subsequent decolonization would be an efficient way of reducing the incidence of infections caused by this bacterium.

MeSH terms

  • Acinetobacter / drug effects
  • Acinetobacter / isolation & purification
  • Anti-Bacterial Agents / therapeutic use
  • Drug Resistance, Microbial*
  • Drug Resistance, Multiple, Bacterial
  • Enterococcus / drug effects
  • Enterococcus / isolation & purification
  • Female
  • Fracture Fixation / adverse effects
  • Fracture Fixation, Internal / adverse effects*
  • Fractures, Bone / complications*
  • Fractures, Bone / surgery
  • Fractures, Bone / therapy
  • Humans
  • Internal Fixators / microbiology*
  • Male
  • Microbial Sensitivity Tests
  • Prevalence
  • Prosthesis-Related Infections / diagnosis
  • Prosthesis-Related Infections / drug therapy
  • Prosthesis-Related Infections / microbiology*
  • Pseudomonas aeruginosa / drug effects
  • Pseudomonas aeruginosa / isolation & purification
  • Retrospective Studies
  • Risk Factors
  • Romania / epidemiology
  • Staphylococcal Infections / complications
  • Staphylococcal Infections / drug therapy*
  • Staphylococcal Infections / epidemiology
  • Staphylococcus aureus / drug effects
  • Staphylococcus aureus / isolation & purification*
  • Traumatology

Substances

  • Anti-Bacterial Agents