Analysis of risk factors, pathogenic bacteria characteristics, and drug resistance of postoperative surgical site infection in adults with limb fractures.
10.1016/j.cjtee.2024.04.007
- Author:
Yan-Jun WANG
1
;
Zi-Hou ZHAO
2
;
Shuai-Kun LU
3
;
Guo-Liang WANG
1
;
Shan-Jin MA
4
;
Lin-Hu WANG
1
;
Hao GAO
1
;
Jun REN
1
;
Zhong-Wei AN
1
;
Cong-Xiao FU
1
;
Yong ZHANG
1
;
Wen LUO
5
;
Yun-Fei ZHANG
6
,
7
Author Information
1. Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, Xi'an, 710038, China.
2. Air Force Medical University, Xi'an, 710032, China.
3. Orthopedic Oncology Institute of PLA, Xi'an, 710038, China.
4. Department of Urology, Second Affiliated Hospital, Air Force Medical University, Xi'an, 710038, China.
5. Department of Ultrasound, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China. Electronic address: 503883752@qq.com.
6. Department of Orthopaedics, Second Affiliated Hospital, Air Force Medical University, Xi'an, 710038, China. Electronic address: tdbone@
7. com.
- Publication Type:Journal Article
- Keywords:
Drug sensitivity;
Fracture;
Pathogens;
Risk factors;
Surgical site infection
- MeSH:
Humans;
Surgical Wound Infection/epidemiology*;
Male;
Female;
Risk Factors;
Retrospective Studies;
Middle Aged;
Adult;
Case-Control Studies;
Fractures, Bone/surgery*;
Aged;
Drug Resistance, Bacterial;
Logistic Models;
Anti-Bacterial Agents/therapeutic use*;
Incidence;
Bacteria/drug effects*
- From:
Chinese Journal of Traumatology
2025;28(4):241-251
- CountryChina
- Language:English
-
Abstract:
PURPOSE:We carried out the study aiming to explore and analyze the risk factors, the distribution of pathogenic bacteria, and their antibiotic-resistance characteristics influencing the occurrence of surgical site infection (SSI), to provide valuable assistance for reducing the incidence of SSI after traumatic fracture surgery.
METHODS:A retrospective case-control study enrolling 3978 participants from January 2015 to December 2019 receiving surgical treatment for traumatic fractures was conducted at Tangdu Hospital of Air Force Medical University. Baseline data, demographic characteristics, lifestyles, variables related to surgical treatment, and pathogen culture were harvested and analyzed. Univariate analyses and multivariate logistic regression analyses were used to reveal the independent risk factors of SSI. A bacterial distribution histogram and drug-sensitive heat map were drawn to describe the pathogenic characteristics.
RESULTS:Included 3978 patients 138 of them developed SSI with an incidence rate of 3.47% postoperatively. By logistic regression analysis, we found that variables such as gender (males) (odds ratio (OR) = 2.012, 95% confidence interval (CI): 1.235 - 3.278, p = 0.005), diabetes mellitus (OR = 5.848, 95% CI: 3.513 - 9.736, p < 0.001), hypoproteinemia (OR = 3.400, 95% CI: 1.280 - 9.031, p = 0.014), underlying disease (OR = 5.398, 95% CI: 2.343 - 12.438, p < 0.001), hormonotherapy (OR = 11.718, 95% CI: 6.269 - 21.903, p < 0.001), open fracture (OR = 29.377, 95% CI: 9.944 - 86.784, p < 0.001), and intraoperative transfusion (OR = 2.664, 95% CI: 1.572 - 4.515, p < 0.001) were independent risk factors for SSI, while, aged over 59 years (OR = 0.132, 95% CI: 0.059 - 0.296, p < 0.001), prophylactic antibiotics use (OR = 0.082, 95% CI: 0.042 - 0.164, p < 0.001) and vacuum sealing drainage use (OR = 0.036, 95% CI: 0.010 - 0.129, p < 0.001) were protective factors. Pathogens results showed that 301 strains of 38 species of bacteria were harvested, among which 178 (59.1%) strains were Gram-positive bacteria, and 123 (40.9%) strains were Gram-negative bacteria. Staphylococcus aureus (108, 60.7%) and Enterobacter cloacae (38, 30.9%) accounted for the largest proportion. The susceptibility of Gram-positive bacteria to Vancomycin and Linezolid was almost 100%. The susceptibility of Gram-negative bacteria to Imipenem, Amikacin, and Meropenem exceeded 73%.
CONCLUSION:Orthopedic surgeons need to develop appropriate surgical plans based on the risk factors and protective factors associated with postoperative SSI to reduce its occurrence. Meanwhile, it is recommended to strengthen blood glucose control in the early stage of admission and for surgeons to be cautious and scientific when choosing antibiotic therapy in clinical practice.
