[Geriatric Proximal Femoral Fracture and Urinary Tract Infection - Considerations for Perioperative Infection...

Area of Science:

• Geriatric Medicine
• Infectious Diseases
• Orthopedic Surgery

Background:

• Standard perioperative infection prophylaxis for proximal femoral fractures (PFF) uses cephalosporins.
• Elderly patients are susceptible to chronic infections, posing risks for surgical hygiene.
• This study investigated urinary tract colonization and deep wound infections in geriatric PFF patients to identify prophylaxis gaps.

Purpose of the Study:

• To characterize urinary tract colonization in geriatric patients with PFF.
• To observe bacterial development and resistance in deep wound infections over a decade.
• To evaluate the effectiveness of current perioperative infection prophylaxis.

Main Methods:

• Investigated urinary tract colonization and microbial resistance in 351 geriatric PFF patients upon admission (Sept 2013–Nov 2015).
• Retrospectively analyzed deep wound infections, microbiological data, and resistance trends in 2161 PFF patients operated between 2005–2014.
• Compared infection rates and pathogen resistance in femoral neck fractures and per-/subtrochanteric fractures.

Main Results:

• Bacteriuria (BU) detected in 35.61% of patients; 47.2% of these had manifest urinary tract infections.
• Multi-resistant pathogens found in 10.4% of BU cases; 26.4% were cefuroxime-resistant.
• Pathogen resistance to cephalosporins increased from 43% to 81% between 2005-2009 and 2010-2014, with a shift towards resistant enterococci.

Conclusions:

• Increasing prevalence of multidrug-resistant pathogens and cephalosporin resistance in geriatric PFF patients is evident.
• Perioperative cephalosporin prophylaxis is ineffective due to rising resistance.
• Antibiotic resistance is a growing concern, especially in nursing homes, requiring revised prophylaxis strategies for geriatric patients.