Selection of new pathogens during antibiotic treatment or prolonged antibiotic prophylaxis in orthopedic surgery
Main Article Content
Abstract
In orthopedic surgery regarding open or infected wounds, both the current antibiotic therapy as well as the perioperative antibiotic prophylaxis, may select new pathogens leading to iterative debridement and changing the antibiotic regimens targeting more resistant microorganisms.
The risk of finding new and more resistant pathogens is relatively high (5%-15%) and exceeds the incidence of primary surgical site infections (SSI) after elective orthopedic surgery with primary wound closures. Based on a narrative review of the current scientific literature, we summarize mechanisms and associations of such a pathogen selection by therapeutic or prophylactic agents and focus on the importance of an adequate initial debridement and on an effective antibiotic stewardship.
Keywords:
antibiotic therapy; antibiotic prophylaxis; osteoarticular infection; selection pressure; new surgical site infections
Article Details
How to Cite
FRIEDL, Susanne et al.
Selection of new pathogens during antibiotic treatment or prolonged antibiotic prophylaxis in orthopedic surgery.
Medical Research Archives, [S.l.], v. 12, n. 4, apr. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5277>. Date accessed: 27 july 2024.
doi: https://doi.org/10.18103/mra.v12i4.5277.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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2. Uçkay I, Hoffmeyer P, Lew D, Pittet D. Prevention of surgical site infections in orthopaedic surgery and bone trauma: state-of-the-art update. J Hosp Infect 84 (2013): 5-12, doi: 10.1016/j.jhin.2012.12.014.
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4. Falagas ME, Bliziotis IA, Kasiakou SK, Samonis G, Athanassopoulou P et al. Outcome of infections due to pandrug-resistant (PDR) Gram-negative bacteria. BMC Infect Dis 5 (2005): 24, doi: 10.1186/1471-2334-5-24.
5. Carattoli A. Plasmids and the spread of resistance. Int J Med Microbiol 303 (2013): 298-304, doi: 10.1016/j.ijmm.2013.02.001.
6. Pfeifer Y, Cullik A, Witte W. Resistance to cephalosporins and carbapenems in Gram-negative bacterial pathogens. Int J Med Microbiol 300 (2010): 371-379, doi:10.1016/j.ijmm.2010.04.005.
7. Uçkay I, Lebowitz D, Kressmann B, Lipsky BA, Gariani K. Influence of Skin Commensals on Therapeutic Outcomes of Surgically Debrided Diabetic Foot Infections-A Large Retrospective Comparative Study. Antibiotics (Basel) 3 (2023): 316. doi: 10.3390/antibiotics12020316
8. Carrara E, Pfeffer I, Zusman O, Leibovici L, Paul M. Determinants of inappropriate empirical antibiotic treatment: systematic review and meta-analysis, Int J Antimicrob Agents 51 (2018): 548-553, doi: 10.1016/j.ijantimicag.2017.12.013.
9. Sax H, Kuster SP, Tehrany YA, Ren R, Uçkay I et al. Eight-year sustainability of a successful intervention to prevent urinary tract infection: A mixed-methods study. Am J Infect Control 44 (2016): 820-824, doi: 10.1016/j.ajic.2016.01.013
10. Uçkay I, Sax H, Gayet-Agéron A, Ruef C, Mühlemann K et al. High proportion of healthcare-associated urinary tract infection in the absence of prior exposure to urinary catheter: a cross-sectional study. Antimicrob Resist Infect Control 2 (2013): 5, doi: 10.1186/2047-2994-2-5
11. Wuarin L, Abbas M, Harbarth S, Waibel F, Holy D et al. Changing perioperative prophylaxis during antibiotic therapy and iterative debridement for orthopedic infections? PLoS One 14 (2019): 0226674,
doi: 10.1371/journal.pone.0226674
12. Burnett RS, Aggarwal A, Givens SA, McClure JT, Morgan PM et al. Prophylactic antibiotics do not affect cultures in the treatment of an infected TKA: a prospective trial. Clin Orthop Relat Res 468 (2010): 127-134, doi: 10.1007/s11999-009-1014
13. Stephan A, Thürmer A, Glauche I, Nowotny J, Zwingenberger S et al., Does preoperative antibiotic prophylaxis affect sonication-based diagnosis in implant-associated infection? J Orthop Res 39 (2021): 2646-2652,
doi: 10.1002/jor.25015.
14. Al-Mayahi M, Cian A, Lipsky BA, Suvà D, Müller C et al. Administration of antibiotic agents before intraoperative sampling in orthopedic infections alters culture results. J Infect 71 (2015): 518-525, doi: 10.1016/j.jinf.2015.08.002.
15. Cohen ME, Salmasian H, Li J, Liu J, Zachariah P et al. Surgical Antibiotic Prophylaxis and Risk for Postoperative Antibiotic-Resistant Infections. J Am Coll Surg 255 (2017): 631-638, doi: 10.1016/j.jamcollsurg.2017.08.010.
16. Jamei O, Gjoni S, Zenelaj B, Kressmann B, Belaieff W et al. Which Orthopaedic Patients Are Infected with Gram-negative Non-fermenting Rods? J Bone Jt Infect 2 (2017): 73-76, doi: 10.7150/jbji.17171
17. Uçkay I, Pires D, Agostinho A, Guanziroli N, Öztürk M et al. Enterococci in orthopaedic infections: Who is at risk getting infected? J Infect 75 (2017): 309-314, doi: 10.1016/j.jinf.2017.06.008.
18. Cooper CC, Stein GE, Mitra S, Abubaker A, Havlichek DH. Long-Acting Lipoglycopeptides for the Treatment of Bone and Joint Infections. Surg Infect (Larchmt) 22 (2021): 771-779, doi: 10.1089/sur.2020.413.
19. Uçkay I, Kressmann B, Malacarne S, Toumanova A, Jaafar J et al. A randomized, controlled study to investigate the efficacy and safety of a topical gentamicin-collagen sponge in combination with systemic antibiotic therapy in diabetic patients with a moderate or severe foot ulcer infection. BMC Infect Dis 18 (2018): 361, doi: 10.1186/s12879-018-3253-z
20. Soldevila-Boixader L, Fernández AP, Laguna JM, Uçkay I. Local Antibiotics in the Treatment of Diabetic Foot Infections: A Narrative Review. Antibiotics (Basel) 12 (2023): 124, doi: 10.3390/antibiotics12010124.
21. Hasler A, Unterfrauner I, Olthof MGL, Jans P, Betz M et al. Deep surgical site infections following double-dose perioperative antibiotic prophylaxis in adult obese orthopedic patients. Int J Infect Dis 108 (2021): 537-542, doi: 10.1016/j.ijid.2021.06.008.
22. Uçkay I, Harbarth S, Ferry T, Lübbeke A, Emonet S et al. Meticillin resistance in orthopaedic coagulase-negative staphylococcal infections. J Hosp Infect 79 (2011): 248-253, doi: 10.1016/j.jhin.2011.06.014
23. Uçkay I, Lübbeke A, Harbarth S, Emonet S, Tovmirzaeva L et al. Low risk despite high endemicity of methicillin-resistant Staphylococcus aureus infections following elective total joint arthroplasty: a 12-year experience. Ann Med 44 (2012): 360-368, doi: 10.3109/07853890.2010.550932.
24. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32 (2004): 470-485, doi: 10.1016/S0196655304005425.
25. Khalil D, Hultin M, Rashid MU, Lund B. Oral microflora and selection of resistance after a single dose of amoxicillin. Clin Microbiol Infect 11 (2016): 1-4, doi: 10.1016/j.cmi.2016.08.008
26. Davat M, Wuarin L, Stafylakis D, Abbas M, Harbarth S et al. Should antibiotic prophylaxis before orthopedic implant surgery depend on the duration of pre-surgical hospital stay? Antimicrob Resist Infect Control 7 (2018): 131, doi: 10.1186/s13756-018-0421-2.
27. Dunkel N, Pittet D, Tovmirzaeva L, Suvà D, Bernard L et al. Short duration of antibiotic prophylaxis in open fractures does not enhance risk of subsequent infection. Bone Joint J 95-B (2013): 831-837,
doi: 10.1302/0301-620X.95B6.30114.
28. Gonzalez A, Suvà D, Dunkel N, Nicodeme JD, Lomessy A et al. Are there clinical variables determining antibiotic prophylaxis-susceptible versus resistant infection in open fractures? Int Orthop 38 (2014): 2323-2327, doi: 10.1007/s00264-014-2395-x.
29. Uçkay I, Agostinho A, Belaieff W, Toutous-Trellu L, Scherer-Pietramaggiori S et al. Noninfectious wound complications in clean surgery: epidemiology, risk factors, and association with antibiotic use. World J Surg 35 (2011): 973-980, doi: 10.1007/s00268-011-0993-y.
30. Pérez-Prieto D, Portillo ME, Puig-Verdié L, Alier A, Gamba C et al. Preoperative antibiotic prophylaxis in prosthetic joint infections: not a concern for intraoperative cultures. Diagn Microbiol Infect Dis 86 (2016): 442-445,
doi: 10.1016/j.diagmicrobio.2016.09.014.
31. Ghanem E, Parvizi J, Clohisy J, Burnett S, Sharkey PF et al. Perioperative antibiotics should not be withheld in proven cases of periprosthetic infection. Clin Orthop Relat Res 461 (2007): 44-47,
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