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[The current pathogen spectrum--what are we fighting against?]
S Scheithauer1, H Häfner, S W Lemmen
1Zentralbereich für Krankenhaushygiene und Infektiologie, Universitätsklinikum Aachen (RWTH), Pauwelsstraße 30, 52074 Aachen, Deutschland.
Abstract:
Surgical site infections are mainly caused by bacteria from the patients' skin or gut flora representing endogenous infections. In orthopedic and trauma surgery the skin commensals dominate and as a consequence Gram-positive bacteria are the main pathogens, particularly S. aureus. Additionally and especially in the case of foreign body infections, less virulent pathogens, e.g. coagulase-negative staphylococci play an important role. Due to newer microbiological techniques in detecting pathogens the spectrum of causative organisms is steadily increasing. As known for other nosocomial infections the relevance of multidrug resistant bacteria in surgical site infections is growing and the key player is methicillin-resistant S. aureus (MRSA); however vancomycin-resistant enterococci (VRE), extended spectrum betalactamases and/or carbapenemases producing enterobacteria and recently even panresistant Acinetobacter baumannii isolates have to be considered.
Insights
Surgical site infections (SSIs) are primarily caused by endogenous bacteria, with Gram-positive pathogens like Staphylococcus aureus dominating orthopedic surgery. The rise of multidrug-resistant bacteria, including MRSA, poses a growing threat to SSI treatment.
Area of Science:
- Microbiology
- Infectious Diseases
- Surgical Infections
Context:
- Surgical site infections (SSIs) are a significant concern in healthcare settings.
- Endogenous bacteria from the patient's skin or gut flora are the primary cause of SSIs.
- Orthopedic and trauma surgery frequently involve Gram-positive bacteria, particularly Staphylococcus aureus, as causative agents.
Purpose:
- To review the spectrum of pathogens causing surgical site infections.
- To highlight the increasing prevalence of multidrug-resistant organisms in SSIs.
- To discuss the evolving landscape of bacterial pathogens implicated in SSIs.
Summary:
- Gram-positive bacteria, especially Staphylococcus aureus, are the main pathogens in SSIs, particularly in orthopedic surgery.
- Coagulase-negative staphylococci are important in foreign body infections.
- The spectrum of SSI pathogens is expanding due to advanced detection methods, with a notable increase in multidrug-resistant bacteria like MRSA, VRE, and carbapenemase-producing enterobacteria.
Impact:
- Understanding the changing microbial landscape of SSIs is crucial for effective prevention and treatment strategies.
- The emergence of multidrug-resistant organisms necessitates updated clinical guidelines and therapeutic approaches.
- This review emphasizes the need for continuous surveillance and research into novel antimicrobial interventions for SSIs.
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