A cohort study evaluating microorganisms and antibiotic resistance in hand trauma and general plastic surgery trauma...

Plastic surgery input is vital in the management of traumatic wounds, with wound contamination and infection compromising patient outcomes; therefore, knowledge of effective antibiotic treatment and microbiological resistance is paramount. This cohort study, performed at a regional tertiary referral Plastic Surgery Centre, analysed patients presenting with Hand Trauma and General Plastic Surgery Trauma (October 2020 to September 2021). Wound swab and patient demographic data were analysed from a real-time microbiology database with corresponding antibiotic resistances. Patients were further stratified by age. Nonparametric categorical data were analysed using the chi-squared test. Overall, 1323 positive organism swab episodes (POSE) were analysed from 689 patients (Hand Trauma = 427, General Plastic Surgery Trauma = 262), returning 22 microorganism varieties. Differences in POSE were demonstrated between the top 5 isolated microorganisms in Hand Trauma (Staphylococcus aureus [SAUR] = 33%, Staphylococcus species [SSE] = 17%, Streptococcus species = 10%, Corynebacterium species [COR] = 6% and Escherichia coli [ECOL] = 5.3%) and General Plastic Surgery Trauma (SAUR = 18%, Unidentified coliform 1 [COL1] = 13.3%, Streptococcus species = 12%, Enterococcus species [ENTSE] = 10% and Pseudomonas species [PSE] = 9%) groups. Corynebacterium particularly in Hand Trauma may cause wound infection, exacerbated by factors, such as prolonged hospital stay, diabetes mellitus and invasive surgery, and has displayed multi-drug resistance; therefore, it is likely an important pathogen to be considered. Age stratification revealed differences in wound colonisation in General Trauma. There was a greater proportion of SSE in patient wounds in the ≤39 versus the 40-69 years (p = 0.02) and ≥70 (p = 0.01) years age groups; Streptococcus species (STREP) was higher in the ≤39 versus ≥70 years age group (p = 0.03); ENTSE was higher in the 40-69 versus ≤39 years age group (p = 0.03). These data highlight the changing landscape of colonisation by microorganisms in Hand Trauma and General Plastic Surgery Trauma wounds, most notably by age, and are clinically useful when considering empirical treatment.