Predominance of multidrug-resistant Gram-negative organisms as cause of surgical site infections at a private tertiary care hospital in Mumbai, India

Broad-spectrum antibiotic prophylaxis in tumor and infected orthopedic surgery-the prospective-randomized, microbiologist-blinded, stratified, superiority trials: BAPTIST Trials

BACKGROUND

The perioperative antibiotic prophylaxis with 1st or 2nd generation cephalosporins is evidence-based in orthopedic surgery. There are, however, situations with a high risk of prophylaxis-resistant surgical site infections (SSI).

METHODS

We perform a superiority randomized controlled trial with a 10% margin and a power of 90% in favor of the broad-spectrum prophylaxis. We will randomize orthopedic interventions with a high risk for SSI due to selection of resistant pathogens (open fractures, surgery under therapeutic antibiotics, orthopedic tumor surgery, spine surgery with American Society of Anesthesiologists (ASA) score ≥ 3 points) in a prospective-alternating scheme (1:1, standard prophylaxis with cefuroxime versus a broad-spectrum prophylaxis of a combined single-shot of vancomycin 1 g and gentamicin 5 mg/kg parenterally). The primary outcome is "remission" at 6 weeks for most orthopedic surgeries or at 1 year for surgeries with implant. Secondary outcomes are the risk for prophylaxis-resistant SSI pathogens, revision surgery for any reason, change of antibiotic therapy during the treatment of infection, adverse events, and the postoperative healthcare-associated infections other than SSI within 6 weeks (e.g., urine infections or pneumonia). With event-free surgeries to 95% in the broad-spectrum versus 85% in the standard prophylaxis arm, we need 2 × 207 orthopedic surgeries.

DISCUSSION

In selected patients with a high risk for infections due to selection of prophylaxis-resistant SSI, a broad-spectrum combination with vancomycin and gentamycin might prevent SSIs (and other postoperative infections) better than the prophylaxis with cefuroxime.

TRIAL REGISTRATION

ClinicalTrial.gov NCT05502380. Registered on 12 August 2022. Protocol version: 2 (3 June 2022).

Factors Contributing to Surgical Site Infections: A Comprehensive Systematic Review of Etiology and Risk Factors

Surgical site infections persist as a substantial concern within the realm of hospital-acquired infections. This enduring issue is further compounded by the mounting challenge of antibiotic resistance, a surge in surgical interventions, and the presence of comorbidities among patients. Thus, a comprehensive exploration of all discernible risk factors, as well as proactive preventive and prophylactic strategies, becomes imperative. Moreover, the prevalence of multidrug-resistant microorganisms has reached alarming proportions. Consequently, there is an acute need to investigate and scrutinize all potential therapeutic interventions to counter this burgeoning threat. Consequently, the primary objective of this review is to meticulously assess the origins and risk elements intertwined with surgical site infections across a diverse spectrum of surgical procedures. As the medical landscape continues to evolve, this critical analysis seeks to provide a nuanced understanding of the multi-faceted factors contributing to surgical site infections, with the overarching aim of facilitating more effective management and mitigation strategies. By exploring these dimensions comprehensively, we endeavor to enhance patient safety and the quality of surgical care in this era of evolving healthcare challenges.

The Emergence of Multiple Antibiotic Resistance in Culture Sensitivities of Post-surgical Patients in Lahore General Hospital, Lahore

Objective

The purpose of this study is to isolate the organisms which are developing resistance and to recognize the drugs against which resistance has emerged so that antibiotic policy can be formulated for the proper and effective use of antibiotics.

Setting and design

An observational study was conducted for a period of six months from July 1, 2021 and December 31, 2021 in LGH.

Methods

Statistics regarding the culture and sensitivity of the organisms isolated from different sources were collected from the surgery department. 195 cultural and sensitivity reports were analyzed for identification of genus/species of bacteria and sensitivity of the organism. 

Results

Out of 195 culture reports, 124 showed significant growth of organisms exhibiting resistance to either single or multiple drugs. Escherichia and acinobactor was the most common organism isolated with a total of 30 each (24%, 24%), followed by pseudomonas 21 (17%), Klebsiella was 13 (10%), Proteus was 10 (8%), Methicillin-resistance Staph-aureus was seven (5%), Methicillin-sensitive Staph-aureus was five (4%), Staphylococcus epidermidis was four (3%), Providencia, Streptococci, Enterobacter species and Citrobacter species were one (1%).

Maximum resistance was detected with frequently used first-line antimicrobials such as Ceftriaxone, ampicillin and Clavulanic acid. Least resistant were Azithromycin, Cefoxitin, Cefaclor among the gram-negative and gram-positive bacteria.

Conclusion

Antimicrobial resistance (AMR) was more against frequently used antibiotics that are accessible for an extended duration. Variation of resistance and sensitivity pattern with time is identified. Periodic AMR monitoring and rotation of antibiotics are suggested to restrict further emergence of resistance.