Ilker Uçkay1, Daniela Pires2, Americo Agostinho2, Nastassia Guanziroli3, Mehmet Öztürk3, Placido Bartolone3, Philippe Tscholl3, Michael Betz3, Didier Pittet4. 1. Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Switzerland; Service of Infectious Diseases, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Switzerland; Orthopaedic Surgery Service, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Switzerland. Electronic address: ilker.uckay@hcuge.ch. 2. Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Switzerland. 3. Orthopaedic Surgery Service, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Switzerland. 4. Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Switzerland; Service of Infectious Diseases, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Switzerland.
Abstract
Some orthopaedic patients might be at risk for enterococcal infections and might benefit from adapted perioperative prophylaxis. METHODS: We performed a single-center cohort of adult patients with orthopaedic infections. RESULTS: Among 2740 infection episodes, 665 surgeries (24%) involved osteosynthesis material, including total joint arthroplasties. The recommended perioperative prophylaxis was cefuroxime (or vancomycin in case of documented MRSA body carriage). Patients had received antibiotic therapy before surgery in 1167 episodes (43%); among them with potential anti-enterococcal activity (penicillins, glycopeptides, imipenem, linezolid, daptomycin, aminoglycosids, tetracyclins) in 725 (62%) cases. Overall, enterococci were identified in intraoperative samples of 100 different infections (3.6%) (Enterococcus faecalis, 95; Enterococcus faecium, 2; and other enterococci, 3). However, only 15/100 (15%) enterococcal infections were monomicrobial and 19 were nosocomial (19/2740; 0.7%), of which 15 had previous cephalosporin perioperative prophylaxis without other antibiotic exposure. This association to prior cephalosporin use was significant (Pearson-χ2-test; 148/2640 vs. 15/100, p < 0.01). By multivariate analysis, the presence of diabetic foot infection (odds ratio 1.9, 95% confidence interval 1.2-2.9), and polymicrobial infection (OR 6.0, 95%CI 3.9-9.4) were the main predictors of enterococcal infection, while sex, age, and type of material were not. CONCLUSIONS: Community-acquired or nosocomial enterococcal infections in orthopaedic surgery are mostly polymicrobial, rare and very seldom attributed to a nosocomial origin. Thus, even if they are formally associated with prior cephalosporin use, we do not see a rational for changing our antibiotic prophylaxis.
Some orthopaedic patients might be at risk for enterococcal infections and might benefit from adapted perioperative prophylaxis. METHODS: We performed a single-center cohort of adult patients with orthopaedic infections. RESULTS: Among 2740 infection episodes, 665 surgeries (24%) involved osteosynthesis material, including total joint arthroplasties. The recommended perioperative prophylaxis was cefuroxime (or vancomycin in case of documented MRSA body carriage). Patients had received antibiotic therapy before surgery in 1167 episodes (43%); among them with potential anti-enterococcal activity (penicillins, glycopeptides, imipenem, linezolid, daptomycin, aminoglycosids, tetracyclins) in 725 (62%) cases. Overall, enterococci were identified in intraoperative samples of 100 different infections (3.6%) (Enterococcus faecalis, 95; Enterococcus faecium, 2; and other enterococci, 3). However, only 15/100 (15%) enterococcal infections were monomicrobial and 19 were nosocomial (19/2740; 0.7%), of which 15 had previous cephalosporin perioperative prophylaxis without other antibiotic exposure. This association to prior cephalosporin use was significant (Pearson-χ2-test; 148/2640 vs. 15/100, p < 0.01). By multivariate analysis, the presence of diabetic foot infection (odds ratio 1.9, 95% confidence interval 1.2-2.9), and polymicrobial infection (OR 6.0, 95%CI 3.9-9.4) were the main predictors of enterococcal infection, while sex, age, and type of material were not. CONCLUSIONS: Community-acquired or nosocomial enterococcal infections in orthopaedic surgery are mostly polymicrobial, rare and very seldom attributed to a nosocomial origin. Thus, even if they are formally associated with prior cephalosporin use, we do not see a rational for changing our antibiotic prophylaxis.
Authors: Ilker Uçkay; Dominique Holy; Madlaina Schöni; Felix W A Waibel; Tudor Trache; Jan Burkhard; Thomas Böni; Benjamin A Lipsky; Martin C Berli Journal: Endocrinol Diabetes Metab Date: 2021-02-09