Abstract
ObjectiveThe aims of the study were to analyse the surgical site infections (SSIs) in patients operated at an orthopaedic ward and to describe the drug-resistance of the aetiology of those infections. Also, analyse the possibility of SSI control through microbiological surveillance. Additionally, we have studied the information inferred by aggregating cumulative antibiograms for the SSIs of the studied orthopaedic unit.DesignCross-sectional studies carried out in 2013–2015.Setting and patientsOrthopaedic and Trauma Surgery Unit in Sosnowiec, Poland; 5995 patients, 5239 operations.MethodsRetrospective laboratory-based data collection study of surgical site infections.ResultsSSI incidence rate was 6.6%, in the implantations—hip prosthesis 5.8% and knee prosthesis 5.4%, about 6 times higher compared with European HAI-Net. SSIs were usually caused by Gram-positive bacteria (56%). The prevalence of MDR microorganisms was 22.6%, and mainly concerned the Gram-negative bacilli: 97.6% of Acinetobacter baumannii and 50.0% of Klebsiella pneumoniae were multidrug-resistant. On the basis of what the Formula for Rational Empiric Antimicrobial Therapy analysis has shown, the use of amikacin, imipenem and ciprofloxacin has been recommended as the most efficient in the empirical therapy of SSIs.ConclusionsThe infection control was a significant problem at the studied orthopaedic unit, as evidenced by the SSI incidence rate significantly higher than expected. We suggest implementing the infection control and prevention based on evidence-based medicine, and a unit-based surveillance. A cumulative unit-based antibiogram reflects the drug-susceptibility pattern for the strains from the infections acquired at the unit.
Highlights
Surveillance is a systematic collection, analysis and interpretation of health data. It is essential for the planning, implementation and evaluation of public health practice, especially when hospital-acquired infections (HAIs) and antimicrobial resistance are concerned [1]
The incidence of surgical site infections (SSIs) in surgical operations is estimated at 1.4–20%, depending on the procedure implemented: it amounts to 1–3% for a primary arthroplasty, but is significantly higher for a revision arthroplasty
The causative pathogens depend on the type of surgery; the main etiological agents are Gram-positive cocci, especially Staphylococcus spp.: Staphylococcus aureus and coagulase-negative staphylococci, in the endoarthroplasty, their share amounting to 70%, in orthopaedic trauma–related SSI about 35% [2,3,4,5]
Summary
Surveillance is a systematic collection, analysis and interpretation of health data. It is essential for the planning, implementation and evaluation of public health practice, especially when hospital-acquired infections (HAIs) and antimicrobial resistance are concerned [1].The European Centre for Disease Control and Prevention (ECDC) recommends an active, targeted surveillance of certain types of HAIs, including surgical site infections (SSIs).International Orthopaedics (2019) 43:2009–2016The incidence of SSIs in surgical operations is estimated at 1.4–20%, depending on the procedure implemented: it amounts to 1–3% for a primary arthroplasty, but is significantly higher for a revision arthroplasty. Surveillance is a systematic collection, analysis and interpretation of health data. It is essential for the planning, implementation and evaluation of public health practice, especially when hospital-acquired infections (HAIs) and antimicrobial resistance are concerned [1]. The European Centre for Disease Control and Prevention (ECDC) recommends an active, targeted surveillance of certain types of HAIs, including surgical site infections (SSIs). The incidence of SSIs in surgical operations is estimated at 1.4–20%, depending on the procedure implemented: it amounts to 1–3% for a primary arthroplasty, but is significantly higher for a revision arthroplasty. Numerous patient- and procedure-related factors influence the risk of SSI. Potential patient-related factors include malnutrition (serum albumin concentration), higher age, coexisting infection and diabetes. The risk is elevated by a prolonged pre-operative hospitalisation [6, 7]
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