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Pathogenic analysis in different types of orthopedic implant infections
Hao Shen1, Jin Tang2, Yanjie Mao1
1Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200233, China.
Background:
Diversity of orthopedic infections with various local environments affects the pattern and prevalence of pathogens. It is not well-characterized whether different pathogens have different propensity to cause different types of orthopedic infections. We aimed to investigate the frequency of different pathogens derived from orthopedic infections, and determine the relationship between the prevalence of clinical isolates and the type of orthopedic implants, especially focusing on staphylococci.
Methods:
From January 2006 to December 2011, orthopedic infections were identified retrospectively from clinical microbiology laboratory and orthopedic medical records. The sources of orthopedic infections were divided into two main groups: those associated with implants and those not associated with implants. Implants-associated infections were further subdivided into five subgroups: arthroplasty, internal fixation, external fixation, internal and external fixation, and others. We analyzed microbiological spectrum in different groups and subgroups. Antibiotic susceptibility of staphylococci was analyzed.
Results:
Only coagulase-negative staphylococci (CoNS) was significantly more likely to be associated with implants-associated infections (P = 0.029). The overall pathogens prevalence of arthroplasty was significantly different from other subgroups (P < 0.05). 65% isolates from external fixation was Gram-negative bacteria. Some percentage (55%) of S. aureus and (83%) CoNS were resistant to methicillin. No resistance to glycopeptide was seen in all of staphylococci.
Conclusions:
Staphylococcus aureus was the most frequent isolates in orthopedic infections but was not associated with the presence or absence of implants. Only CoNS was implants-associated, especially for arthroplasty infection. Cefazolin alone is not enough for orthopedic surgery prophylaxis in settings with a high prevalence of methicillin-resistant staphylococci.
Insights
Coagulase-negative staphylococci (CoNS) are linked to orthopedic implant infections, particularly arthroplasty. Staphylococcus aureus is common but not implant-associated. Current prophylaxis may be insufficient against resistant strains.
Area of Science:
- Orthopedic surgery
- Infectious diseases
- Microbiology
Background:
- Orthopedic infections vary by pathogen and local environment.
- The relationship between specific pathogens and orthopedic infection types, especially with implants, requires further characterization.
- Focus on staphylococci in orthopedic infections and their association with implants.
Purpose of the Study:
- Investigate the frequency of different pathogens in orthopedic infections.
- Determine the association between clinical isolates and orthopedic implant types.
- Analyze the prevalence of staphylococci in relation to implant presence.
Main Methods:
- Retrospective analysis of orthopedic infections (2006-2011).
- Categorization of infections into implant-associated and non-implant-associated groups.
- Subdivision of implant infections into arthroplasty, internal fixation, external fixation, and others.
- Analysis of microbiological spectrum and antibiotic susceptibility of staphylococci.
Main Results:
- Coagulase-negative staphylococci (CoNS) showed a significant association with implant-associated infections (P=0.029).
- Pathogen prevalence differed significantly across arthroplasty subgroups (P<0.05).
- High rates of methicillin resistance were observed in Staphylococcus aureus (55%) and CoNS (83%); no glycopeptide resistance was found.
Conclusions:
- Staphylococcus aureus is the most frequent pathogen but not linked to implants.
- CoNS are specifically associated with implant-associated infections, notably arthroplasty.
- Cefazolin prophylaxis may be inadequate due to high methicillin-resistant staphylococci prevalence.
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