Orthopedic postoperative infection profile and antibiotic sensitivity of 2038 patients across 24 countries - Call for region and institution specific surgical antimicrobial prophylaxis

Mengesha MG 1 , Rajasekaran S 2 , Ramachandran K 2 , Sengodan VC 3 , Yasin NF 4 , Williams LM 5 Show all authors , Laubscher M 6 , Watanabe K 7 , Dastagir OZM 8 , Akinmadr A 9 , Fisseha HK 1 , Aziz A 10 , Yurac R 11 , Gebrehana E 1 , AlSaifi M 12 , Pathinathan K 13 , Sudhir G 14 , Shokri AA 15 , Chan Kim Y 16 , Jonayed SA 8 , Kido GR 17 , Ignacio JM 18 , Mohammed MS 19 , Abubakar K 20 , Hakim J 21 , Duwal Shrestha SK 22 , Al Mamun Choudhury A 8 , Diallo M 23 , Molina M 24 , Patwardhan S 25 , Hai Y 26 , Ramat AM 27 , Kawai M 28 , Cho JH 29 , Shah Kalawar RP 22 , Choi SW 30 , Zarate-Kalfopulos B 31 , Guiroy A 32 , Astur N 33 , Buunaaim AB 34 , Human AL 35 , Zaman AU 36

Affiliations 

  • 1 Hawassa University College of Medicine and Health Sciences, Ethiopia
  • 2 Department of Orthopedics and Spine Surgery, Ganga Medical Centre and Hospital Pvt. Ltd., Mettupalayam Road, Coimbatore, India
  • 3 Institute of Orthopaedics and Traumatology, Coimbatore Medical College, Tamilnadu, India
  • 4 Natioal Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Orthopaedic Surgery Department, Faculty of Medicine, Universiti Malaya, Malaysia
  • 5 University Hospitals Bristol & Weston NHS, United Kingdom
  • 6 Orthopaedic Research Unit (ORU), University of Cape Town, South Africa
  • 7 Department of Orthopaedic Surgery, Keio University School of Medicine, Japan
  • 8 National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
  • 9 Afe Babalola University, Ado-Ekiti, Nigeria
  • 10 Orthopaedic & Spine Unit at Lahore Medical & Dental College / Ghurki Trust Teaching Hospital, Lahore, Pakistan
  • 11 Department of Orthopedics and Traumatology, Universidad Del Desarrollo (UDD). Clinica Alemana de Santiago, Chile
  • 12 University for Medicine and Applied Sciences, Yemen
  • 13 National Hospital-Colombo, Sri Lanka
  • 14 Sri Ramachandra Institute of Higher Education and Research, India
  • 15 Universiti Sains Malaysia, Malaysia
  • 16 Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seol, South Korea
  • 17 Orthopaedic and Traumatology Department, Institute of Orthopedics “Carlos E. Ottolenghiâ€, Hospital Italiano de Buenos Aires, Argentina
  • 18 Department of Orthopedics, University of the Philippines Manila, Manila, Philippines
  • 19 Hosaena University Hospital, Ethiopia
  • 20 National Orthopaedic Hospital, Dala, Kano, Nigeria
  • 21 BIRDEM General Hospital & Ibrahim Medical College, Bangladesh
  • 22 Nepal Armed Police Force Hospital, Nepal
  • 23 Universite NAZI BONI, Burkina Faso
  • 24 Instituto Traumatológico de Santiago, Universidad Finis Terrae, Chile
  • 25 Dept. of Orthopaedics, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
  • 26 Beijing Chaoyang Hospital, Capital Medical University, China
  • 27 University of Maiduguri Teaching Hospital, Nigeria
  • 28 Department of Orthopaedic Surgery, Spine Center, Kitasato Institute Hospital, Japan
  • 29 University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
  • 30 Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Seoul, South Korea
  • 31 Instituto Nacional de Rehabilitacion, Mexico
  • 32 ClÃ-nica de Cuyo, Mendoza, Argentina
  • 33 Hospital Israelita Albert Einstein, Sao Paulo, Brazil
  • 34 University for Development Studies, Ghana
  • 35 University of Cape Town, South Korea
  • 36 Ghurki Trust Teaching Hospital/Lahore Medical and Dental College, Pakistan
J Orthop, 2024 Sep;55:97-104.
PMID: 38681829 DOI: 10.1016/j.jor.2024.04.018

Abstract

PURPOSE: Improper utilization of surgical antimicrobial prophylaxis frequently leads to increased risks of morbidity and mortality.This study aims to understand the common causative organism of postoperative orthopedic infection and document the surgical antimicrobial prophylaxis protocol across various institutions in to order to strengthen surgical antimicrobial prophylaxis practice and provide higher-quality surgical care.

METHODS: This multicentric multinational retrospective study, includes 24 countries from five different regions (Asia Pacific, South Eastern Africa, Western Africa, Latin America, and Middle East). Patients who developed orthopedic surgical site infection between January 2021 and December 2022 were included. Demographic details, bacterial profile of surgical site infection, and antibiotic sensitivity pattern were documented.

RESULTS: 2038 patients from 24 countries were included. Among them 69.7 % were male patients and 64.1 % were between 20 and 60 years. 70.3 % patients underwent trauma surgery and instrumentation was used in 93.5 %. Ceftriaxone was the most common preferred in 53.4 %. Early SSI was seen in 55.2 % and deep SSI in 59.7 %. Western Africa (76 %) and Asia-Pacific (52.8 %) reported a higher number of gram-negative infections whereas gram-positive organisms were predominant in other regions. Most common gram positive organism was Staphylococcus aureus (35 %) and gram-negative was Klebsiella (17.2 %). Majority of the organisms showed variable sensitivity to broad-spectrum antibiotics.

CONCLUSION: Our study strongly proves that every institution has to analyse their surgical site infection microbiological profile and antibiotic sensitivity of the organisms and plan their surgical antimicrobial prophylaxis accordingly. This will help to decrease the rate of surgical site infection, prevent the emergence of multidrug resistance and reduce the economic burden of treatment.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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