Orthopedic Related Infections Research Articles

ANTIBIOTIC RESISTANCE PATTERN IN BACTERIA ISOLATED FROM ORTHOPAEDIC RELATED INFECTIONS

Background. Orthopaedics & Implant related infections continue to pose a problem for the orthopaedicians. An increase in the number of multidrug resistant bacteria stresses the value of an adequate diagnosis, leading to a proper therapy of these patients. To isolate bacteria causing orthopaedic related infecti Objective. Materials ons and determine their antibiotic resistance pattern. & methods. A total of 111 samples were received during the study period in the Department of Microbiology & were processed. Bacteria causing orthopaedic related infections were isolated and their antimicrobial susceptibility testing was determined. . There were 66 (59%) isolates Results that showed culture positivity & were processed. Among which, gram positive cocci were 35 (53%) & gram negative bacilli were 31 (47%). The common gram positive cocci were Methicillin sensitive Staphylococcus aureus 31.81% followed by CoNS 10.6% & MRSA 10.6% While the common gram negative bacilli were Pseudomonas aeruginosa 18.18%, Klebsiella pneumoniae 12.12%, Escherichia coli 7.5%, Citrobacter freundii 4.5%, Proteus mirabilis 3.03% & Acinetobacter baumannii 1.51%. Most of the gram positive cocci were resistance to the following antibiotics- ciprooxacin, penicillin, erythromycin. Most of the gram negative bacilli were resistance to the cephalosporins group of drugs mainly ceftriaxone & ceftazidime . Gram positive cocci were the commone Conclusion st isolates from orthopaedic related infection as compare to gram negative bacteria. Antibiotic resistance pattern should be given adequate stress so as to get better results regarding orthopaedic related infections

1018. Shifting Antimicrobial Practice to Minimize Length of Stay in Orthopedic Infections: Analysis from an Academic Tertiary Care Center

Abstract Background Increased hospital length of stay (LOS) has been associated with increased rates of readmission, nosocomial infections, and cost during hospitalizations for orthopedic-related infections (HOIs). We hypothesized that Infectious Diseases (ID) consultation is associated with increased LOS for HOIs due to pending culture results delaying final recommendations. We assessed patient and care factors affecting LOS, including duration and timing of ID consultation, and identified process improvements to expedite discharge for HOIs. Methods We performed retrospective chart review of HOI admissions with ID consultation at Vanderbilt University Medical Center from May-August 2021. Differences in HOIs discharged <1 vs. >1 day after ID final recommendations were examined using Fisher’s exact, Chi-squared, and Wilcoxon rank sum testing. Clustering by patient for those with >1 admission was performed. We used multivariable and propensity score weighted negative binomial regression models to estimate adjusted rate ratios (aRR) and 95% confidence intervals (CI) for number of days followed by an ID consultant and LOS. Results HOIs discharged <1 day after ID final recommendations (69/105) had shorter median LOS (3 vs. 8 days, p< 0.001) (Figure 1), more oral-only antibiotic regimens (41% vs. 17%, p=0.003), and more frequent discharge to home (91% vs. 53%, p< 0.001). HOIs discharged >1 day after ID final recommendations were more likely to undergo multiple surgeries (28% vs. 12%, p=0.019) and peripherally inserted central catheter (PICC) placement (69% vs. 43%, p=0.013). For each additional day of ID consultation, there was associated increase in LOS (multivariable aRR 1.12, 95% CI 1.02-1.23; weighted aRR 1.12, 95% CI 0.99-1.26). Figure 1.Length of Stay after ID Final Recommendations Conclusion ID consultation is unlikely to be the primary barrier to hospital discharge but may be a marker for more complicated HOIs and increased LOS. Most patients with prolonged stays were discharged >1 day after ID final recommendations. Implementation of protocols to promote prompt ID consultation, streamline PICC placement, and coordinate outpatient intravenous antibiotics may accelerate transitions of care and discharges. Disclosures Milner B. Staub, MD, MPH, Gilead: Stocks/Bonds|Johnson & Johnson: Stocks/Bonds.

A retrospective observational study of traumatic orthopaedic: related infections in Cambodia

<p class="abstract"><strong><span lang="EN-US">Background:</span></strong><span lang="EN-US"> The objective of this study was to establish the type of microbiology along with antimicrobial resistance related to orthopedic related trauma infections in this area in order to help guide diagnosis and treatment regimens.</span></p><p class="abstract"><strong><span lang="EN-US">Methods:</span></strong>This study evaluated the microbial etiology of orthopedic-related infections (ORI) between September 2015 and September 2016 in three tertiary hospitals in Phnom Penh, Cambodia. Clinical records were for clinical features and demographics. Standard laboratory bacteriology was used to recover, identified and perform antibiotic susceptibility testing (AST) by disk diffusion or broth microdilution<span lang="EN-US">.<strong></strong></span></p><p class="abstract"><strong><span lang="EN-US">Results:</span></strong>119 patients were categorized as ORI cases. In the cases identified, median interquartile range (IQR) age was 38 (IQR: 26-46) years and 80.0% were male. Of the 119 ORI cases, a total of 156 bacterial strains were recovered, identified and after review, 128 of these pathogenic bacterial strains underwent AST. Among the gram-positive pathogens, the following susceptibilities were as follows: <em>Staphylococcus aureus</em> (n=57) (Methicillin-resistant<em> S. aureus</em> (n=35; 61.4%), (Methicillin‐sensitive<em> S. aureus</em> (n=22; 38.6%)), coagulase-negative<em> staphylococcus</em> (all MS-CoNS; n=6) and four isolates of <em>Enterococcus </em>sp<em>.</em> (non-VRE). A total of 44 gram-negative pathogens were recovered and AST was performed. Among these 44, a total of nine extended-spectrum beta-lactamase (ESBL) producing strains (20.5%) were discovered including <em>Escherichia coli</em> (n=8), <em>Klebsiella pneumoniae</em> (n=1) and carbapenemase-resistant <em>Enterobacteriaceae</em> (CRE) (<em>Morganella morganii</em>). In addition, a single <em>E. coli</em> isolate contained both the ESBL and CRE genotypes was noted.</p><p class="abstract"><strong><span lang="EN-US">Conclusions:</span></strong>This data suggests that ORI rates in Cambodia appear to be comparable to other studies in the literature. However, further studies need to be done in order to establish definitive data related to orthopedic infections in the region.</p>

Clinical usefulness of multiplex PCR-lateral flow for the diagnosis of orthopedic-related infections

Objectives: Polymerase chain reaction (PCR)-based assays are being increasingly used for the diagnosis of orthopedic-related infections. Unfortunately, classical PCR requires imaging devices that are expensive and complex. We previously developed the PCR-lateral flow (PCR-LF) method, which does not require any additional imaging device. In the present study, the objective was to determine whether PCR-LF tests could be used to effectively diagnose orthopedic-related infections.Methods: In this study, we used PCR-LF to diagnose common causes of orthopedic-related infections and compared the results to those from conventional bacterial cultures of the same samples.Results: Notably, for 228 synovial fluid or pus specimens, the sensitivity and specificity of bacterial cultures were 53.5% and 97.7%, respectively, compared to 61.6% and 89.9% for PCR-LF. Although the difference in sensitivity between bacterial cultures and PCR-LF was not significant, when our analysis was limited to cases with suspected periprosthetic joint infection, the sensitivity of PCR-LF (66.1%) was superior to that of bacterial cultures (42.9%).Conclusion: This study indicates that PCR-LF is a useful method for diagnosing orthopedic-related infections.

Review-Antibiotic Beads

The appropriate use of antimicrobial agents has decreased morbidity and mortality from orthopedic-related infections. Although systemic antibiotic use has been used for many years, new methods of local antibiotic delivery may result in increased antibiotic levels, decreased toxicity, and possibly greater efficacy. Antibioticloaded beads are bactericidal, have a dose-dependent killing curve, remain stable when exposed to heat and are soluble in water. Antibiotic beads are available in the form of biodegradable and nonbiodegradable which has its own advantages and disadvantages.

MRSA new treatments on the horizon: Current status

There is a choice of anti-MRSA antibiotic available with proven efficacy in the treatment of complicated skin and skin structure infection (cSSSI). Additional anti-MRSA antibiotics are in development, which have the potential to influence how such infections are managed. The emergence of resistance to current anti-MRSA agents, toxicity, and general lack of oral agents with proven efficacy for deep seated infection justify the development of new agents. However, there is a relative dearth of information specific to patients with orthopaedic-related infection. Combination therapy is often used in these patients, although there is a paucity of controlled trial data to support particular antibiotic combinations. As the choice of anti-MRSA agents increases, so does the need to identify which are best for the large variety of infections included in the group of cSSSIs. This is particular true for infections occurring in orthopaedic patients where poorly vascularised tissue, trauma or implanted prosthetic material, pose specific challenges.

Clinical Experience With Daptomycin in Patients With Orthopedic-Related Infections

A retrospective chart review was performed for all patients (N = 31) treated by the authors with daptomycin over a 12-month period for infections of bone and joints, spine, and prostheses. Data were collected for demographic patient information, therapy duration, surgical procedures, culture site and results, side effects, and clinical outcomes. Infection types included osteomyelitis (n = 16), prosthetic joints (n = 8), laminectomy wounds without osteomyelitis (n = 6), and diskitis with bacteremia (n = 1). Twenty-four patients' infections involved methicillin-resistant Staphylococcus aureus isolates (MRSA); 5 had methicillin-sensitive S. aureus (MSSA); and 4 had methicillin-resistant Staphylococcus epidermidis (MRSE). Most received daptomycin as salvage therapy at dosages of 6 mg/kg/d; mean therapy duration was 38 days (range 14-56). Daptomycin therapy was successful in 87% (27/31) of patients, determined by culture results, and magnetic resonance imaging (MRI) and computed tomography (CT) scans. In most cases, daptomycin was effective for treatment of difficult bone and joint infections caused by MRSA in this patient population.