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Orthopedic surgical site infections: analysis of causative bacteria and implications for antibiotic stewardship
Thomas D Norton, Faith Skeete, Yanina Dubrovskaya
1Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY. joseph.bosco@nyumc.org.
Abstract:
Data that can be used to guide perioperative antibiotic prophylaxis in our era of emerging antibiotic resistance are limited. We reviewed orthopedic surgeries complicated by surgical site infections (SSIs). Eighty percent of 69 arthroplasty and 80 spine fusion SSIs were infected with Gram-positive bacteria; most were staphylococcal species; and more than 25% of Staphylococcus aureus and more than 65% of coagulase-negative staphylococci were methicillin-resistant. Gram-negative bacteria were isolated from 30% of arthroplasty SSIs and 25% of spine fusion SSIs. Resistance to cefazolin was higher than 40%. A significant proportion of SSIs were caused by resistant organisms, and antibiotic guidelines were altered to provide more adequate surgical prophylaxis.
Insights
Perioperative antibiotic prophylaxis is challenged by rising antibiotic resistance. This study found high rates of resistant Gram-positive and Gram-negative bacteria in orthopedic surgical site infections (SSIs), necessitating guideline updates.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Pharmacology
Background:
- Emerging antibiotic resistance limits data for guiding perioperative antibiotic prophylaxis.
- Surgical site infections (SSIs) pose a significant challenge in orthopedic procedures.
Purpose of the Study:
- To analyze the microbial landscape and antibiotic resistance patterns in orthopedic SSIs.
- To inform updated antibiotic prophylaxis guidelines for orthopedic surgeries.
Main Methods:
- Retrospective review of orthopedic surgeries with confirmed SSIs.
- Identification of bacterial pathogens and assessment of antibiotic susceptibility, including methicillin-resistance in staphylococci.
Main Results:
- Gram-positive bacteria, predominantly staphylococci, caused 80% of arthroplasty and spine fusion SSIs.
- High rates of methicillin-resistant Staphylococcus aureus (>25%) and coagulase-negative staphylococci (>65%) were observed.
- Gram-negative bacteria were isolated in 30% of arthroplasty and 25% of spine fusion SSIs.
- Resistance to cefazolin exceeded 40%.
Conclusions:
- A significant proportion of orthopedic SSIs are caused by multidrug-resistant organisms.
- Current antibiotic prophylaxis guidelines require revision to address prevalent resistance patterns.
- Updated guidelines are crucial for effective perioperative antibiotic prophylaxis in orthopedic surgery.
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