Changing perioperative prophylaxis during antibiotic therapy and iterative debridement for orthopedic infections?


Autoři: Lydia Wuarin aff001;  Mohamed Abbas aff002;  Stephan Harbarth aff002;  Felix Waibel aff003;  Dominique Holy aff004;  Jan Burkhard aff004;  Ilker Uçkay aff001
Působiště autorů: Orthopedic Surgery Service, Geneva University Hospitals, Geneva, Switzerland aff001;  Infection Control Program, Geneva University Hospitals, Geneva, Switzerland aff002;  Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland aff003;  Internal Medicine, Balgrist University Hospital, Zurich, Switzerland aff004;  Infectiology and Infection Control, Balgrist University Hospital, Zurich, Switzerland aff005;  Unit for Clinical and Applied Research, Balgrist University Hospital, Zurich, Switzerland aff006
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226674

Souhrn

Background

Perioperative antibiotic prophylaxis in non-infected orthopedic surgery is evident, in contrast to prophylaxis during surgery for infection. Epidemiological data are lacking for this particular situation.

Methods and findings

It is a single-center cohort on iterative surgical site infections (SSIs) in infected orthopedic patients. We included 2480 first episodes of orthopedic infections (median age 56 years and 833 immune-suppressed): implant-related infections (n = 648), osteoarticular infections (1153), and 1327 soft tissue infections. The median number of debridement was 1 (range, 1–15 interventions). Overall, 1617 infections (65%) were debrided once compared to 862 cases that were operated multiple times (35%). Upon iterative intraoperative tissue sampling, we detected pathogens in 507 cases (507/862; 59%), of which 241 (242/507; 48%) corresponded to the initial species at the first debridement. We witnessed 265 new SSIs (11% of the cohort) that were resistant to current antibiotic therapy in 174 cases (7% of the cohort). In multivariate analysis, iterative surgical debridements that were performed under current antibiotic administration were associated with new SSIs (odds ratio 1.6, 95%CI 1.2–2.2); mostly occurring after the 2nd debridement. However, we failed to define an ideal hypothetic prophylaxis during antibiotic therapy to prevent further SSIs.

Conclusions

Selection of new pathogens resistant to ongoing antibiotic therapy occurs frequently during iterative debridement in orthopedic infections, especially after the 2nd debridement. The new pathogens are however unpredictable. The prevention, if feasible, probably relies on surgical performance and wise indications for re-debridement instead of new maximal prophylactic antibiotic coverage in addition to current therapeutic regimens.

Klíčová slova:

Antibiotic resistance – Antibiotics – Bacterial pathogens – Gram negative bacteria – Orthopedic surgery – Soft tissue infections – Staphylococcal infection – Surgical and invasive medical procedures


Zdroje

1. 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 2013; 84:5–12. doi: 10.1016/j.jhin.2012.12.014 23414705

2. WHO Global guidelines for the prevention of surgical site infections. WHO, Geneva, 2016.

3. Parvizi J, Gehrke T, Chen AF. Proceedings of the International Consensus Meeting on Periprosthetic Joint Infection. Bone Joint J 2013; 95-B: 1450–1452. doi: 10.1302/0301-620X.95B11.33135 24151261

4. Gonzalez A, Suvà D, Dunkel N, Nicodème JD, Lomessy A, Lauper N, et al. Are there clinical variables determining antibiotic prophylaxis-susceptible versus resistant infection in open fractures? Int Orthop 2014; 38:2323–2327. doi: 10.1007/s00264-014-2395-x 24951947

5. Al-Mayahi M, Cian A, Lipsky BA, Suvà D, Müller C, Landelle C, et al. Administration of antibiotic agents before intraoperative sampling in orthopedic infections alters culture results. J Infect 2015; 71:518–525. doi: 10.1016/j.jinf.2015.08.002 26283328

6. Ballus J, Lopez-Delgado JC, Sabater-Riera J, Perez-Fernandez XL, Betbese AJ, Roncal JA. Surgical site infection in critically ill patients with secondary and tertiary peritonitis: epidemiology, microbiology and influence in outcomes. BMC Infect Dis 2015; 15:304. doi: 10.1186/s12879-015-1050-5 26223477

7. Uçkay I, Vernaz-Hegi N, Harbarth S, Stern R, Legout L, Vauthey L, et al. Activity and impact on Ab use and costs of a dedicated infectious diseases consultant on a septic orthopaedic unit. J Infect 2009; 58:205–212. doi: 10.1016/j.jinf.2009.01.012 19232739

8. Uçkay I, Lübbeke A, Harbarth S, Emonet S, Tovmirzaeva L, Agostinho A, et al. Low risk despite high endemicity of methicillin-resistant Staphylococcus aureus infections following elective total joint arthroplasty: a 12-year experience. Ann Med 2012; 44:360–368. doi: 10.3109/07853890.2010.550932 21352084

9. Jugun K, Vaudaux P, Garbino J, Pagani L, Hoffmeyer P, Lew D, et al. The safety and efficacy of high-dose daptomycin combined with rifampicin for the treatment of Gram-positive osteoarticular infections. Int Orthop 2013; 37:1375–1380. doi: 10.1007/s00264-013-1856-y 23519823

10. Uçkay I, Gariani K, Pataky Z, Lipsky BA. Diabetic foot infections: state-of-the-art. Diabetes Obes Metab 2014; 16:305–316. doi: 10.1111/dom.12190 23911085

11. Dunkel N, Belaieff W, Assal M, Corni V, Karaca Ş, Lacraz A, et al. Wound dehiscence and stump infection after lower limb amputation: risk factors and association with antibiotic use. J Orthop Sci 2012; 17:588–594. doi: 10.1007/s00776-012-0245-5 22669444

12. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999; 27:97–132. 10196487

13. Uçkay I, Harbarth S, Ferry T, Lübbeke A, Emonet S, Hoffmeyer P, et al. Methicillin-resistance in orthopaedic coagulase-negative staphylococcal infections. J Hosp Infect 2011; 79:248–253. doi: 10.1016/j.jhin.2011.06.014 21955452

14. Performance Standards for Antimicrobial Susceptibility Testing; 17th Informational Supplement. Clinical and Laboratory Standards Institute. Wayne, Pennsylvania; USA; 2007.

15. European Committee on Antimicrobial Susceptibility Testing. Breakpoint Tables for Interpretation of MICs, Version 4, 2014. http://www.eucast.org/clinical_breakpoints

16. Al-Mayahi M, Cian A, Kressmann B, de Kalbermatten B, Rohner P, Egloff M, et al. Associations of diabetes mellitus with orthopaedic infections. Infect Dis (Lond) 2016; 48:70–73.

17. Al-Mayahi M, Betz M, Müller DA, Stern R, Tahintzi P, Bernard L, et al. Remission rate of implant-related infections following revision surgery after fractures. Int Orthop 2013; 37:2253–2258. doi: 10.1007/s00264-013-2092-1 24052163

18. Seghrouchni K, van Delden C, Dominguez D, Benkabouche M, Bernard L, Assal M, et al. Remission after treatment of osteoarticular infections due to Pseudomonas aeruginosa versus Staphylococcus aureus: a case-controlled study. Int Orthop 2012; 36:1065–1071. doi: 10.1007/s00264-011-1366-8 21983903

19. Uçkay I, Bernard L. Gram-negative versus gram-positive prosthetic joint infections. Clin Infect Dis 2010; 50:795. doi: 10.1086/650540 20175257

20. Misteli H, Widmer AF, Rosenthal R, Oertli D, Marti WR, Weber WP. Spectrum of pathogens in surgical site infections at a Swiss university hospital. Swiss Med Wkly 2011; 140:13146.

21. Tumminello A, Dominguez D, Lebowitz D, Bartolone P, Betz M, Hannouche D, et al. Staphylococcus aureus versus streptococci in orthopaedic infections. Infect Dis (Lond) 2017; 49:716–718.

22. Uçkay I, Pires D, Agostinho A, Guanziroli N, Öztürk M, Bartolone P, et al. Enterococci in orthopaedic infections: Who is at risk getting infected? J Infect 2017; 75:309–314. doi: 10.1016/j.jinf.2017.06.008 28676409

23. Agostinho A, Renzi G, Haustein T, Jourdan G, Bonfillon C, Rougemont M, et al. Epidemiology and acquisition of extended-spectrum beta-lactamase-producing Enterobacteriaceae in a septic orthopedic ward. Springer Plus 2013; 2:91. doi: 10.1186/2193-1801-2-91 23539506

24. Vauthey L, Uçkay I, Abrassart S, Bernard L, Assal M, Ferry T, et al. Vancomycin-induced DRESS syndrome in a female patient. Pharmacology 2008; 82:138–141. doi: 10.1159/000142729 18607115

25. Chotai S, Wright PW, Hale AT, Jones WA, McGirt MJ, Patt JC, et al. Does Intrawound Vancomycin Application During Spine Surgery Create Vancomycin-Resistant Organism? Neurosurgery 2017; 80:746–753. doi: 10.1093/neuros/nyw097 28387851

26. Bell S, Davey P, Nathwani D, Marwick C, Vadiveloo T, Sneddon J, et al. Risk of AKI with gentamicin as surgical prophylaxis. J Am Soc Nephrol 2014; 25:2625–2632. doi: 10.1681/ASN.2014010035 24876113

27. Branch-Elliman W, Ripollone JE, O'Brien WJ, Itani KMF, Schweizer ML, Perencevich E, et al. Risk of surgical site infection, acute kidney injury, and Clostridium difficile infection following antibiotic prophylaxis with vancomycin plus a beta-lactam versus either drug alone: A national propensity-score-adjusted retrospective cohort study. PLoS Med 2017; 14:1002340.

28. Cranny G, Elliott R, Weatherly H, Chambers D, Hawkins N, Myers L, et al. A systematic review and economic model of switching from non-glycopeptide to glycopeptide antibiotic prophylaxis for surgery. Health Technol Assess 2008; 12:1–147.

29. Walker H, Patton A, Bayne G, Marwick C, Sneddon J, Davey P, et al. Reduction in post-operative acute kidney injury following a change in antibiotic prophylaxis policy for orthopaedic surgery: an observational study. J Antimicrob Chemother 2016; 71:2598–2605. doi: 10.1093/jac/dkw166 27231276

30. Uçkay I, Agostinho A, Belaieff W, Toutous-Trellu L, Scherer-Pietramaggiori S, Andres A, et al. Noninfectious wound complications in clean surgery: epidemiology, risk factors, and association with antibiotic use. World J Surg 2011; 35:973–980. doi: 10.1007/s00268-011-0993-y 21327598


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2019 Číslo 12