Drug resistance of pathogens causing nosocomial infection in orthopedics from 2012 to 2017: a 6-year retrospective study

• DOI: 10.21203/rs.2.9477/v1
• Publication Date: 2019-05-07T00:21:13Z
• Authors: Bin Zhang; Xiaowei Yang; Runsheng Guo; Banglin Xie; Qi Lai; Jiaxiang Xu; Niya Hu; Lijun Wan; Min Dai
• Keywords: Male; 0301 basic medicine; Staphylococcus aureus; Time Factors; Diseases of the musculoskeletal system; Penicillins; Multidrug resistance; 03 medical and health sciences; 0302 clinical medicine; Drug Resistance, Bacterial; Enterobacter cloacae; Escherichia coli; Humans; Retrospective Studies; Orthopedic surgery; Hospital-acquired infections; Cross Infection; Drug Resistance, Multiple; Anti-Bacterial Agents; 3. Good health; Orthopedics; RC925-935; Drug resistance; Ampicillin; Female; RD701-811; Research Article

Abstract Abstract

Background

Hospital-acquired infections (HAIs) are an emerging global problem that increases in-hospital mortality, length of stay, and cost. Orthopedics departments experience a particularly high infection rate, partially due to their heavy reliance on invasive medical devices. We performed a 6-year retrospective study to provide valuable insight into appropriate antibiotic use in HAI cases. We also aimed to understand how hospitals could reduce pathogen drug resistance in a population that overuses antibiotics.

Methods

All data (2012–2017) were obtained from the Hospital Information Warehouse and Clinical Microbiology Laboratory.

Results

We isolated 1392 pathogen strains from patients admitted to the orthopedics department during 2012–2017. Escherichia coli (14.7%, 204/1392), Enterobacter cloacae (13.9%, 193/1392), and Staphylococcus aureus (11.3%, 157/1392) were the most common pathogens causing nosocomial infections. The dominant gram-negative bacterium was E. coli, with high resistance to ampicillin, levofloxacin, cotrimoxazole, gentamicin, and ciprofloxacin, in that order. E. coli was least resistant to amikacin, cefoperazone-sulbactam, meropenem, imipenem, and piperacillin-tazobactam. The most dominant gram-positive bacterium was S. aureus, highly resistant to penicillin and ampicillin, but not resistant to fluoroquinolones and cotrimoxazole. We also did not observe isolate resistance to nitrofurantoin, linezolid, and vancomycin. Analysis of risk factors related to multidrug-resistant bacteria showed that patients with open fractures were significantly more susceptible to methicillin-resistant S. aureus infections (p < 0.05). Additionally, extended-spectrum β-lactamase-producing E. coli infections occurred significantly more often in patients with degenerative diseases (p < 0.05). Elderly patients tended to be more susceptible to multidrug-resistant bacterial infections, but this outcome was not statistically significant.

Conclusions

Antimicrobial resistance is a serious problem in orthopedics. To effectively control antimicrobial resistance among pathogens, we advocate extensive and dynamic monitoring of MDR bacteria, coupled with careful use of antibiotics.

Key words: hospital acquired infections; orthopedics; drug resistance; multidrug resistance