Bacteriological spectrum of infections in orthopaedic implants and their antibiotic susceptibility pattern

Abstract

Background: Orthopaedic implant infections are one of the most challenging complications among orthopaedic surgeries which occurs despite the best management practices. The rise of antibiotic-resistant bacteria is set to pose a major challenge in the treatment of these infections. Aim: The present study is done to identify the risk factors and bacteriological isolates responsible for orthopaedic implant infections and to study their antimicrobial susceptibility patterns. Materials and Methods: This was a cross-sectional study carried out at a tertiary care hospital in India over eighteen months on patients presenting with the signs and symptoms of infections post-implant surgery. Microbiological samples were collected & processed as per the standard guidelines. Results: Out of 57 patients with implant infections, 44(77%) had internal fixators & 13 (23%) had prosthesis insertion. 32(56%) patients presented with delayed infection. The most common risk factors were Diabetes, smoking, extensive trauma followed by alcohol consumption. The most common site infected was Tibia. The most common bacteria isolated were S.aureus (28%) followed by Coagulase-negative staphylococci & E.coli (19.2%) each. Among Staphylococci isolates, 59% of the isolates were methicillin-resistant. Among Gram-negative isolates, 56.6% of the isolates were either ESBL or/and AmpC producers and 20% were carbapenemase producers. Conclusion: Despite best management practices, orthopaedic implant-related infections are often encountered. The high incidence of Multidrug-resistant organisms observed in this study is the cause of concern and underscores the need for better preventative and therapeutic strategies like strict adherence to the antibiotic policy and multidisciplinary approach to reduce the incidence & burden of treatment in these infections.