Epidemiology and Drug Resistance Analysis of Mixed Infection in Orthopedic Surgical Sites

Multiplexed bacterial pathogen detection and clinical characteristics of orthopedic infection in hospitalized patients

Introduction

Accurate identification of the etiology of orthopedic infection is very important for correct and timely clinical management, but it has been poorly studied. In the current study we explored the association of multiple bacterial pathogens with orthopedic infection.

Methods

Hospitalized orthopedic patients were enrolled in a rural hospital in Qingdao, China. Wound or exudate swab samples were collected and tested for twelve bacterial pathogens with both culture and multiplex real time PCR.

Results and discussion

A total of 349 hospitalized orthopedic patients were enrolled including 193 cases presenting infection manifestations upon admission and 156 with no sign of infection. Orthopedic infection patients were mainly male (72.5%) with more lengthy hospital stay (median 15 days). At least one pathogen was detected in 42.5% (82/193) of patients with infection while 7.1% (11/156) in the patients without infection (P < 0.001). S. aureus was the most prevalent causative pathogen (15.5%). Quantity dependent pathogen association with infection was observed, particularly for P. aeruginosa and K. pneumoniae, possibly indicating subclinical infection. Most of the patients with detected pathogens had a previous history of orthopedic surgery (odds ratio 2.8, P = 0.038). Pathogen specific clinical manifestations were characterized. Multiplex qPCR, because of its high sensitivity, superior specificity, and powerful quantification could be utilized in combination with culture to guide antimicrobial therapy and track the progression of orthopedic infection during treatment.

Effectiveness of nursing intervention in the operating room to prevent wound infections in patients undergoing orthopaedic surgery: A meta-analysis

Surgical site wound infection is one of the most common postoperative complications in orthopaedic clinical practice. This study employed a meta-analysis approach to comprehensively evaluate the effect of operating room nursing interventions on the prevention of surgical site wound infections in orthopaedic surgical patients. A computer search was conducted using PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), VIP, and Wanfang databases from the inception of each database until May 2023 for randomised controlled trials (RCTs) that investigated the application of operating room nursing interventions in orthopaedic surgery. Two reviewers independently screened the literature, extracted data, and assessed study quality. The meta-analysis was conducted using Stata 17.0. A total of 29 studies involving 3567 patients were included, with 1784 patients in the intervention group, and 1783 patients in the control group. The results of the meta-analysis showed that compared with the control group, the use of operating room nursing interventions significantly reduced the incidence of surgical site wound infection after orthopaedic surgery (2.85% vs. 13.24%; odds ratio: 0.18, 95% confidence interval: 0.14-0.25; p < 0.001). Current evidence suggests that operating room nursing interventions reduce the incidence of surgical site wound infections. However, owing to the limited number and low quality of the studies, more high-quality, large-sample RCTs are needed to further verify these findings.

Analysis of clinical characteristics, pathogen infection, and drug sensitivity of Marine injury patients: A cross-sectional study

The infection rate is high in patients injured at sea, and because of the unique distribution of marine microorganisms, the infection is often not easily controlled effectively with the empirical application of antibiotics. This study aims to consider the clinical characteristics and pathogen infection and drug susceptibility of patients injured at sea. From 2019 to 2021, there were 635 patients injured at sea in Rizhao People's Hospital. We assess the patient's basic condition, while performing bacterial culture and drug susceptibility testing on wound exudate or pus from infected patients. Among the 635 patients injured at sea, 195 people were infected, and the infection rate was 30.71%. Infected patients are usually older, have longer prehospital visits, and have lower normal levels of red blood cells, hemoglobin, total protein, and albumin. The causes of injury in infected patients were mainly avulsion and puncture injuries, and the types of injuries were mainly bone fracture, vascular injury, and nerve injury. A total of 305 strains of pathogenic bacteria were cultured in 195 patients. Gram-negative bacteria accounted for 77.05% (235 strains), of which Proteus was the most. Gram-positive bacteria accounted for 22.95% (70 strains), of which Staphylococcus aureus was the most. Gram-negative bacilli were sensitive to aminoglycosides, lactam antibiotics, carbapenems antibiotics, sulfonamides, quinolones, fourth-generation cephalosporins, and antibacterial drugs containing enzyme inhibitors, while most of the bacteria were resistant to penicillins, first-generation cephalosporins, and second-generation cephalosporins. Gram-positive bacteria were sensitive to quinuptin/dafoptin, rifampicin, linezolid, gentamicin, tigacycline, and vancomycin but resistant to penicillin antibiotics. Due to the particularity of marine injuries, patients are prone to infection. Pathogen culture and drug sensitivity analysis play an important role in guiding antiinfective treatment for marine injured patients.

Microbiological Profile and Drug Resistance Analysis of Postoperative Infections following Orthopedic Surgery: A 5-Year Retrospective Review

Background

The distribution of postoperative orthopedic infection and their susceptibility pattern to antibiotics vary regionally and change over time. The incidence of methicillin-resistant Staphylococcus aureus infection is rising worldwide. Therefore, knowledge of the frequency of the causative microorganisms and their susceptibility to antibiotics are necessary for an improved therapeutic outcome. This study aims to study the frequency and distribution of postoperative orthopedic infection and their resistance pattern to antibiotics.

Methods

The study utilized a retrospective design that took place over a period of 5 years from 2016 and 2020 at a tertiary care hospital. The bacterial culture testing was performed by a recommended method. Descriptive statistics were used to analyze the data.

Results

A total of 158 patients (100 males and 58 females) with positive cultures of postoperative orthopedic infection were included. The most common infective organism was Staphylococcus aureus, 64 patients (38.1%); coagulase-negative staphylococci, 40 patients (23.8%); Klebsiella species, 14 patients (8.3%); and Enterococcus species, Escherichia coli, and Pseudomonas aeruginosa in 10 patients (6%). Data also showed that gram-positive bacteria were detected in 118 patients (70.8%), while gram-negative microorganisms were found in 50 patients (29.8%). Among Staphylococcus aureus, 79.7% were MRSA, and vancomycin was the most effective antibiotic in staphylococcus infections. The antibiotics with the greatest sensitivity to gram-positive bacteria were vancomycin, linezolid, tigecycline, moxifloxacin, and nitrofurantoin, while the antibiotics for gram-negative bacteria with greater sensitivity were tigecycline, amikacin, ertapenem, imipenem, and cefotaxime.

Conclusion

Staphylococcus aureus is the most common postoperative orthopedic infection, which was predominantly MRSA with vancomycin being the most effective antibiotic. In addition, the results showed a high resistance pattern to the commonly used antibiotics, leaving few choices. Antibiotic agents should be carefully selected according to specific drug sensitivity through routine monitoring of drug resistance patterns and to help formulate hospital antibiotic policy.

Epidemiologic Correlation and Drug Resistance Analysis of Pathogenic Bacteria in Different Open Limb Injury External Conditions

Objective

To study the epidemiological correlation and drug resistance of external factors of infection caused by open injury of limbs to pathogens.

Methods

This experiment is a retrospective study. We took the geographical location and climate of Nanchang, Jiangxi Province, China as the background, analyzed 2017 strains of pathogens from 1589 patients with limb trauma infection in a University Affiliated Hospital from 2012 to 2017. Patients were divided into three groups according to the type of incision: I, In‐hospital infection of clean limb incision, II, In‐hospital infection with open injury, III, Community infection with open injury of the limb. Groups II and Groups III were divided into six subgroups according to the causes of trauma, including: accidents from non‐motor vehicles, machinery, cutting/piercing, pedestrian injuries, struck by/against, pedal cycles, and other injuries. We found eight common pathogens of orthopedic infection, which were mainly divided into Gram‐positive bacteria (G+, mainly including Staphylococcus) and Gram‐negative bacteria (G‐, mainly Enterobacteriaceae). The relationship between main pathogens and damage mechanism, apparent temperature and relative humidity was discussed in this study. SPSS v22.0 was used for statistical analysis of the data. Friedman's two‐way ANOVA was used to analyze the difference between the injury mechanism and incidence of pathogenic bacteria. Linear regression was used to determine the trend between the incidence of major pathogens and seasonal temperature and humidity. The level of significance was set as P < 0.05.

Results

There was no significant difference in the distribution of pathogens between Groups II and Groups III (P>0.05). The drug resistance of Groups III was significantly higher than that of Groups II and Groups I. G+ bacteria were resistant to cephalosporin, ceftriaxone and other cephalosporins and erythromycin and other macrolides. They were sensitive to vancomycin and linezolid. G‐ were resistant to the first‐ and the second‐generation cephalosporins, including cefotetan and cefazolin, and ampicillin and other penicillins, while they were sensitive to third‐generation cephalosporins, such as ceftazidime, as well as to levofloxacin and other quinolones, meropenem, and other beta‐lactamases. The correlation between the injury mechanism and infection of pathogenic bacteria was not significant. The monthly average apparent temperature and relative humidity were correlated with the infection rate of pathogenic bacteria.

Conclusion

In open injury of extremities, apparent temperature and relative humidity is an important risk factor for infection by pathogenic bacteria and the drug resistance of pathogenic bacteria in out‐of‐hospital infection was lower than that of hospital infection.

Significant Difference in Antimicrobial Resistance of Coagulase Negative Periprosthetic Joint Infection in Septic Revision Total Knee Arthroplasty Between Two Major Orthopedic Centers

BACKGROUND

Antimicrobial resistance is recognized as a major public health threat. It occurs naturally; however, an excessive antibiotic use and misuse of antibiotics accelerate the process. Periprosthetic joint infections (PJI) are becoming harder to treat as the efficacy of antibiotics is becoming lower. The aim of this study was to compare the resistance of coagulase-negative staphylococci (CNS) to antibiotics identified after revision TKAs for PJI between two major orthopedic centers.

METHODS

A review of all revision TKAs, undertaken between 2006 and 2018 in two orthopedic centers, was performed, including all those meeting the consensus criteria for PJI, in which CNS were identified. There were no major differences in surgical approach and tissue sampling between both centers. Thirteen commonly used antibiotics were tested at both centers.

RESULTS

The 132 strains were analyzed for their resistance to 13 different antibiotics. Staphylococcus epidermidis was identified in 70.5% cultures, followed by Staphylococcus capitis in 8.3% cultures. The comparison of antibiotic resistance between two centers was statistically significant to penicillin (P = .001), oxacillin (P = .011), cefuroxime (P = .044), levofloxacin (P = .006), moxifloxacin (P = .008), tetracycline (P < .001), rifampicin (P < .001) and vancomycin (P < .001). The difference of resistance of CNS was not statistically significant to fosfomycin, clindamycin, teicoplanin, erythromycin and ampicillin.

CONCLUSIONS

The resistance of CNS to antibiotics differs significantly between two major orthopedic centers that are geographically fairly close. Monitoring of bacteriological analyses in each referral center should be continuously performed. Close monitoring is needed for more efficient antibiotic treatment of and prophylaxis against PJI.

Connections between Orthopedic Conditions and Oxidative Stress: Current Perspective and the Possible Relevance of Other Factors, Such as Metabolic Implications, Antibiotic Resistance, and COVID-19

The general opinion in the literature is that these topics remain clearly understudied and underrated, with many unknown aspects and with controversial results in the respective areas of research. Based on the previous experience of our groups regarding such matters investigated separately, here we attempt a short overview upon their links. Thus, we summarize here the current state of knowledge regarding the connections between oxidative stress and: (a) orthopedic conditions; (b) COVID-19. We also present the reciprocal interferences among them. Oxidative stress is, of course, an interesting and continuously growing area, but what exactly is the impact of COVID-19 in orthopedic patients? In the current paper we also approached some theories on how oxidative stress, metabolism involvement, and even antibiotic resistance might be influenced by either orthopedic conditions or COVID-19. These manifestations could be relevant and of great interest in the context of this current global health threat; therefore, we summarize the current knowledge and/or the lack of sufficient evidence to support the interactions between these conditions.