Title: A Study on Bacteriological Spectrum of Post-Operative Orthopaedic Implant Infections and their Antibiotic Sensitivity Pattern in a Tertiary Care Hospital
Authors: Jyoti, Saroj Golia, Suhani. S. Manasa
DOI: https://dx.doi.org/10.18535/jmscr/v5i4.64
Abstract
Background: Post operative infections in orthopedic implants is a major problem in orthopedic patients nowadays which can lead to implant failure and in severe cases can even lead to amputation and mortality.These are mainly associated with Open reduction and internal fixation (ORIF) of fractures with implants and prosthesis which has become the first line in the management of fractures in most traumacentres in recent times. This is also associated with high morbidity and cost for patient during his hospital stay.
Objectives: The objective of this paper is to isolate and identify the bacteriological isolates responsible and their antimicrobial sensitivity from post-operative orthopedic implant infections.
Materials and Methods: This was a prospective study carried out at a tertiary care hospital in India over a period of six months. The study was conducted on 50 cases of infected implants from orthopaedic wards, admitted in DR.B.R Ambedkar Medical College, Bangalore from 1stJuly to 1st December 2016.Pus samples were collected using two sterile swabs .One is used for Grams stain and other for inoculation on Mac conkey and blood agar. Susceptibility testing was performed by Kirby-Bauer disk diffusion technique.
Results: Out of the 50 samples processed, 40 (80%) of specimens showed culture positivity. Staphylococcus aureus 14(35%) was the predominant isolate followed by Escherichia coli 10(25%),Klebsiellaspp 8(20%), Pseudomonasspp 5(12.5%),Acinetobacterspp2(5%) and Proteus spp1 (2.5%). All Gram-positive cocci were susceptible to vancomycin and linezolid.
Gram negative bacilli were resistant to ceftriaxone (84.6%), ciprofloxacin(69.2%), cotrimoxazole (69.2%)and sensitive to carbapenems and piperaciillintazobactam. ESBL production is seen in 11(61%) cases of Gram negative bacteria.
Pseudomonas isolates were susceptible to piperacillin-tazobactam, and meropenem.
Conclusion: Orthopedic implant post-operative infections are a major concern in the present scenario. There is an increase incidence of multidrug resistance among the pathogens isolated from these isolates. Adequate preventive measures should be taken to prevent these antibiotic resistance amongst organisms. In this study Gram Positive Organisms has emerged as major threat for orthopedic implants.
Key Words: Bacterial isolates; Antibiogram; Orthop edic infection; Wounds; ESBL.
References
1. Orthopedic Infections: Current Concepts. Available from ttp://www.houstonmetho-dist.org/basic.cfm?id=36831. [Last accessed on 2015 Jun 06].
2. Nichols RL. Current strategies for prevention of surgical site infections. Curr Infect Dis Rep. 2004;6(6):426-34.
3. Agrawal AC, Jain S, Jain RK, Raza HK. Pathogenic bacteriain an orthopaedic hospital in India. J Infect Dev Ctries.2008;2:120-3.
4. Jain V, Ramani VK, Kaore N. Antimi-crobial susceptibilitypattern amongst aerobic bacteriological isolates in infectedwounds of patients attending tertiary care hospital in centralIndia. Int J CurrMicrobiolAppl Sci. 2015;4(5):711-9.
5. Jain A, Bhatawadekar S, Modak M. Bacteriologicalprofile of surgical site infection from a tertiary care hospital, from Western India. Indian J Appl Res 2014;4(1):397-400.
6. Hauser CJ, Adams CA Jr, Eachempati SR. Council of the Surgical Infection Society. Surgical infection society guideline: prophylactic antibiotic use in open fractures: an evidence-based guideline. Surg Infect (Larchmt) 2006; 7:379-405.
7. Anglen JO. Comparison of soap and antibiotic solutions for irrigation of lower-limb open fracture wounds. A prospective, randomized study. J. Bone Joint Surg Am 2005; 87:1415-22.
8. Mahomed NN, Barrett JA, Katz JN, Phillips CB, Losina E, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA. Rates and outcomes of primary and revision total hipreplacement in the United States Medicare population. J Bone Joint Surg Am.2003;85:27-32.
9. Ayers DC, Dennis DA, Johanson NA, Pellegrini VD Jr. Common complications of total knee arthroplasty. J Bone Joint Surg Am. 1997;79:278-311.
10. Rao N, Cannella B, Crossett LS, Yates AJ Jr, McGough R 3rd. A preoperative decolonization protocol for Staphylo-coccus aureus prevents orthopaedic infections. ClinOrthopRelat Res. 2008; 466:1343-8.
11. Fulkerson E, Valle CJ, Wise B, Walsh M, Preston C, Di Cesare PE. Antibiotic susceptibility of bacteria infecting total joint arthroplasty sites. J Bone Joint Surg Am. 2006;88:1231-7
12. Fitzgerald RH, Jr. Infected total hip arthroplasty: diagnosis and treatment. J Am AcadOrthop Surg. 1995;3:249-62.
13. Costerton JW. Biofilm theory can guide the treatment of device-related orthopaedic infections. ClinOrthopRelat Res. 2005;437:7-11.
14. Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science. 1999;284: 1318-22.
15. Lewis K. Riddle of biofilm resistance. Antimicrob Agents Chemother. 2001;45: 999-1007.
16. CLSI,M100-S26 Performance Standards for Antimicrobial Susceptibility Testing; Twenty-fourth Informational Supplement Jan 2016.
17. CLSI,M100-S26 Performance Standards for Antimicrobial Susceptibility Testing; Twenty-fourth Informational Supplement Jan 2016,110-112 .
18. CLSI,M100-S26 Performance Standards for Antimicrobial Susceptibility Testing; Twenty-fourth Informational Supplement Jan 2016,140-141
19. Devi PV, Reddy PS, Shabnum M. Microbial profile and antibiotic susceptibility pattern of orthopedic infections in a tertiary care hospital: A study from South India. Int J Med Sci Public Health 2017;6 (Online First).Doi: 10.5455/ijmsph.2017.1060318112016
20. Abraham Y, Asrar D, Woldeamanuel Y, Chaka T, Negash D, Wamisho BL. Bacteriology of compound (open) fracture wounds at Tikur-Anbessa specialized hospital, Addis ababa University, Ethiopia. EJHMS 2014; 52:1-10. www.uog.edu.et/journals/index.php/ejhms/article/download/52/33.
21. Gomez J, Rodriguez M, Banos V, Martinez L, AntoniaC, Antonia M, “Orthopedic Implant Infection. Prognostic factors and influence of prolonged antibiotic treatment in its evolution. Prospective study: 1992-1999. Enferm Infec Microbiol Clin 2003; 21:232-36.
22. Zimmerli W, Trampuz A, Ochsner PE. Prosthetic joint infections.NEngl J Med 2004 Oct14; 51(16):1645-54.
23. JyotiSonawane, Narayan Kamanth ,Rita Swaminathan, Kaushal Dosani. Bacterio-logical profile of surgical site infections and their antibiogram in tertiary hospitals in Navy Bombay.Bombay Hospital Journal 2010;52; 358-61.
24. Nitin GoelInsan,NikhilPayal ,Mahesh Singh, Amod Yadav, B.L.Chaudhary, Ambrish Srivastava.Post operative wound infection bacteriology andantibiotic sensitivity pattern. IJCRR2013;5:74-9.
25. Incidence and risk factors for early surgical site infections in elective orthopedic implant surgeris,a prospective study .Feb-2015 Vol 4,Issue 15,Page 2525-2531.
26. Bergqvist S. Observations concerning the presence of pyogenic staphylococci in the nose and their relationship to the antistapholysintitre. Acta Med Scand 1950; 136:343-50.
27. Dan M, Moses Y, Poch F, Asherov J, Gutman R.Carriage of methicillin-resistant S.aureus by nonhospitalized subjects in isral. Infection 1992; 20:332-5.
28. SatyaChandraV,SuryaKiraniKRL.Bacteriological spectrum of post operative orthopedic implant infectionsand their antibiogram.JKIMSU,Vol.5,No.1,January-March,2016.