Assessment of Incidence of Superbugs and Antibiotic Resistance in Orthopaedics, A Cross-Sectional Study
Keywords:
Growth Cultures, Implant Infection, Antibiotic Sensitivity, Antibiotic Resistance.Abstract
Objectives: Due to the presence of metallic implants, orthopedic surgeries are at increased risk of microbiological contamination and infection. Such infections require aggressive and prolonged use of antimicrobial therapy. The objective of our study is to determine the frequency of growth in cultures and identify patterns of new antibiotic resistance from culture growth of infected implant patients.
Methods: Total 188 patients were included in this study which was conducted in Liaquat National Hospital from July 2022 till July 2023. Suspected infections were confirmed biochemically when ESR ?30mm/hour or CRP ?10 mg/dl. Such patients underwent routine surgeries for infection eradication as per routine orthopaedic guidelines. Appropriate body tissue specimens were sampled for culture and sensitivity. Descriptive statistics were calculated.
Results: There were 64.4% male and 35.6% female patients. Mean age was 43.61±14.21 years. Mean ESR and CRP was 63.89±34.92 mm/hour and 6.11±4.54 mg/dl respectively. In 23.9% previous surgical procedure was ORIF. In our study, 87.8% of patients were found with culture growth while most common culture bacterium was MRSA found among 40.6% patients. Most sensitive antibiotic was Vancomycin (67.3%). 13.2% of patients showed no growth indicating significant covert or indolent bacteria.
Conclusion: Culture growth was observed in 87.8% patients with MRSA being the most common organism. Vancomycin was found as most sensitive antibiotic.
References
Willhuber GC, Stagnaro J, Petracchi M, Donndorff A et al. Short-term complication rate following orthopedic surgery in a tertiary care center in Argentina. SICOT-J. 2018;4.
Vishwajith AK, Venkatesha D. Evaluation of aerobic bacterial isolates and its drug susceptibility pattern in Orthopaedic infections. JMSCR. 2014;2(6):1256-62.
Vestby LK, Grønseth T, Simm R, Nesse LL. Bacterial Biofilm and its Role in the Pathogenesis of Disease. Antibiotics. 2020;9(2):59.
Metsemakers W-J, Onsea J, Neutjens E, Steffens E, Schuermans A, McNally M, et al. Prevention of fracture-related infection: a multidisciplinary care package. International Orthopaedics. 2018;41(12):2457-69.
Rather IA, Kim BC, Bajpai VK, Park YH. Self-medication and antibiotic resistance: Crisis, current challenges, and prevention. Saudi J Biol Sci. 2018;24(4):808-12.
Alelign D, Tena T, Tadesse D, Tessema M, Seid M, Oumer Y, et al. Bacteriological Profiles, Antimicrobial Susceptibility Patterns, and Associated Factors in Patients Undergoing Orthopedic Surgery with Suspicion of Surgical Site Infection at Arba Minch General Hospital in Southern Ethiopia. Infection and Drug Resistance. 2022;15:2427-43.
Radhamony NG, Raj R. Analysis of incidence of postoperative wound infection in closed fractures treated by surgical fixation – A prospective study. Annals of Medicine and Surgery. 2021;72:103029.
Bilal M, Karamat A, Basit MS, Bashir MS, Naqvi Q, Hashmi GM. Incidence of Surgical Site Infection in Patients Presented for Orthopaedic Surgery. Pakistan Journal of Medical & Health Sciences. 2022;16(08):289-.
Soomro ZI, Shah KA, Baloch AA, Ali Z. Postoperative Wound Infection in Elective Orthopaedics Implant Surgical Cases at Public Sector Hospital. National Editorial Advisory Board. 2019;30(8):50.
Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF, et al. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. The Journal of Arthroplasty. 2018;33(5):1309-14.e2.
Valya B, Das SK, Kavya T, Vidyasagar V, Begum R. Antibiotic sensitivity and resistance pattern in orthopedic infectious cases of tertiary teaching hospital. INTERNATIONAL JOURNAL OF LIFE SCIENCE AND PHARMA RESEARCH. 2018;7(4):P24-P9.
Wayne P. Clinical and Laboratory Standards Institute: Performance standards for antimicrobial susceptibility testing: 20th informational supplement. CLSI document M100-S20. 2020.
Fokam P, Mvodo A, Handy E, Nana TC, Ngowe MN. Prevalence and predictive risk factors of surgical site infection following orthopaedic surgery in Yaoundé. Revue de Médecine et de Pharmacie. 2022;11(2):1247-50.
Yang J, Zhang X. Analysis of factors affecting surgical infection in orthopaedic patients. Journal of International Medical Research. 2020;48(4):0300060520907776.
Cheng H, Chen BP-H, Soleas IM, Ferko NC, Cameron CG, Hinoul P. Prolonged operative duration increases risk of surgical site infections: a systematic review. Surgical infections. 2018;18(6):722-35.
Yao R, Zhou H, Choma TJ, Kwon BK, Street J. Surgical site infection in spine surgery: who is at risk? Global spine journal. 2018;8(4_suppl):5S-30S.