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Which Orthopaedic Patients Are Infected with Gram-negative Non-fermenting Rods?
Omid Jamei1, Shpresa Gjoni2, Besa Zenelaj1
1Orthopaedic Surgery Service.
Abstract:
: 1st and 2nd generation cephalosporins used for perioperative prophylaxis in orthopaedic surgery do not cover non-fermenting Gram-negative rods (NFR). Epidemiological cohort study of adult patients operated for orthopedic infections between 2004 and 2014 with perioperative cefuroxim or vancomycin prophylaxis. Exclusion of polyneuropathic ischemic foot infections and septic bursitis cases. Of the total 1840 surgical procedures in the study, 430 grew Gram-negative pathogens (23%), of which 194 (11%) were due to NFR and 143 (8%) to Pseudomonas aeruginosa. Overall, 634 episodes (35%) involved orthopaedic implants (321 arthroplasties, 135 plates, 53 nails, and others). In multivariate analysis and group comparisons, especially preoperative antibiotic use (124/194 vs. 531/1456; p<0.01) was significantly associated with NFR. Overall proportion of NFR oscillated between 9% and 13% among our orthopaedic infections. Variables associated with NFR were antibiotic use prior to hospitalization. The low infection rate of NFR following elective surgery and the community-based epidemiology, has led us to keep our standard perioperative prophylaxis unchanged.
Insights
First and second-generation cephalosporins do not cover non-fermenting Gram-negative rods (NFR) in orthopedic surgery. Preoperative antibiotic use was linked to NFR orthopedic infections, but standard prophylaxis remains unchanged due to low NFR rates.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- First and second-generation cephalosporins are standard for perioperative prophylaxis in orthopedic surgery.
- These agents lack coverage for non-fermenting Gram-negative rods (NFR), a potential concern in orthopedic infections.
Purpose of the Study:
- To evaluate the incidence of NFR in orthopedic infections.
- To identify risk factors associated with NFR orthopedic infections.
- To assess the adequacy of current perioperative prophylaxis.
Main Methods:
- Retrospective epidemiological cohort study of adult patients undergoing orthopedic surgery between 2004 and 2014.
- Analysis of perioperative cefuroxime or vancomycin prophylaxis.
- Exclusion of specific infection types like polyneuropathic ischemic foot infections and septic bursitis.
Main Results:
- Out of 1840 procedures, 23% yielded Gram-negative pathogens, with 11% being NFR and 8% Pseudomonas aeruginosa.
- NFR infections were significantly associated with prior antibiotic use (p<0.01).
- The overall proportion of NFR infections ranged from 9% to 13%.
Conclusions:
- Preoperative antibiotic exposure is a significant risk factor for NFR in orthopedic infections.
- Despite the presence of NFR, the low infection rate and community epidemiology support maintaining current standard perioperative prophylaxis.
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