Antibiotic Susceptibility Evaluation in Bacterial Infections from Orthopedic Inpatients with Leg Trauma

The COVID-19 pandemic has profoundly impacted healthcare delivery systems worldwide, but its impact on orthopedic infection patterns remains unclear. This retrospective comparative study analyzed 173 patients with leg trauma-related orthopedic infections from June 2018 to May 2025, divided into two periods based on China's pandemic control policy changes in December 2022: pre-policy adjustment (n = 86) and post-policy adjustment (n = 87). Our study revealed four major pandemic-driven changes: First, patients were significantly younger (50.6 ± 15.0 vs 52.6 ± 16.1 years, p < 0.001) with dramatically reduced hospital stays (16.9 ± 11.3 vs 28.0 ± 26.2 days, p < 0.001). Second, bacterial ecology shifted markedly, with S. aureus prevalence declining from 53.5% to 41.4% while E. faecium emerged exclusively in the post-policy period (4.6%). Third, antibiotic resistance patterns showed divergent trends: β-lactam resistance improved (40.1% to 30.2%), whereas resistance to fluoroquinolones (24.9% to 36.3%), macrolides (40.0% to 59.2%), and lincosamides (40.8% to 52.5%) increased significantly. Fourth, MRSA prevalence among S. aureus isolates rose from approximately 40% to 45%, although glycopeptides and lipopeptides maintained excellent efficacy (≤ 1.1% resistance). These findings highlight pandemic-driven changes in orthopedic infections, necessitating updated antibiotic protocols and strengthened antimicrobial stewardship.