DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20200541

A retrospective observational study of traumatic orthopaedic: related infections in Cambodia

Suresh J. Antony, Dennis Faix, James G. Gollogly, Kim Yong June, Heang Oy, Chin Savuth, Supaprom Chonthida, Shannon D. Putnam

Abstract


Background: The objective of this study was to establish the type of microbiology along with antimicrobial resistance related to orthopedic related trauma infections in this area in order to help guide diagnosis and treatment regimens.

Methods:This study evaluated the microbial etiology of orthopedic-related infections (ORI) between September 2015 and September 2016 in three tertiary hospitals in Phnom Penh, Cambodia. Clinical records were for clinical features and demographics. Standard laboratory bacteriology was used to recover, identified and perform antibiotic susceptibility testing (AST) by disk diffusion or broth microdilution.

Results:119 patients were categorized as ORI cases. In the cases identified, median interquartile range (IQR) age was 38 (IQR: 26-46) years and 80.0% were male. Of the 119 ORI cases, a total of 156 bacterial strains were recovered, identified and after review, 128 of these pathogenic bacterial strains underwent AST. Among the gram-positive pathogens, the following susceptibilities were as follows: Staphylococcus aureus (n=57) (Methicillin-resistant S. aureus (n=35; 61.4%), (Methicillin‐sensitive S. aureus (n=22; 38.6%)), coagulase-negative staphylococcus (all MS-CoNS; n=6) and four isolates of Enterococcus sp. (non-VRE). A total of 44 gram-negative pathogens were recovered and AST was performed. Among these 44, a total of nine extended-spectrum beta-lactamase (ESBL) producing strains (20.5%) were discovered including Escherichia coli (n=8), Klebsiella pneumoniae (n=1) and carbapenemase-resistant Enterobacteriaceae (CRE) (Morganella morganii). In addition, a single E. coli isolate contained both the ESBL and CRE genotypes was noted.

Conclusions:This data suggests that ORI rates in Cambodia appear to be comparable to other studies in the literature. However, further studies need to be done in order to establish definitive data related to orthopedic infections in the region.


Keywords


Cambodia, Orthopedic related infections, Microbiology, Antimicrobial resistance

Full Text:

PDF

References


Jain BK, Banerjee M. Surgical site infections and its risk factors in orthopedics: a prospective study in teaching hospital of central India. Int J Res Med. 2013;2(1):110-3.

Thakore RV, Greenberg SE, Shi H, Foxx AM, Francois EL, Prablek MA, et al. Surgical site infection in orthopedic trauma: A case-control study evaluating risk factors and cost. J Clin Orthop Trauma. 2015;6(4):220-6.

Patzakis MJ, Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res. 1989;243:36-40.

Hout B, Oum C, Men P, Vanny V, Supaprom C, Heang V, et al. Drug resistance in bacteria isolated from patients presenting with wounds at a non-profit Surgical Center in Phnom Penh, Cambodia from 2011-2013. Trop Dis Travel Med Vacc. 2015;1:4.

Maksimovic J, Marković-Denić L, Bumbaširević M, Marinković J, Vlajinac H. Surgical site infections in orthopedic patients: prospective cohort study. Croat Med J. 2008;49(1):58-65.

Ercole FF, Franco LM, Macieira TG, Wenceslau LC, de Resende HI, Chianca TC. Risk of surgical site infection in patients undergoing orthopedic surgery. Rev Lat Am Enfermagem, 2011;19(6):1362-8.

NNIS, National nosocomial infections surveillance (NNIS) system report, data summary from January 1992 through June 2003. Am J Inf Cont. 2003: 481.

Hawkey PM. Multidrug-resistant Gram-negative bacteria: a product of globalization. J Hosp Infect. 2015;89(4):241-7.

Marimuthu K, Ng OT, Bagdasarian N, Tambyah PA. The global challenge of carbapenemases and the critical need for more data. Int J Infect Dis. 2019;84:141-2.

Taitt CR, Leski TA, Heang V, Ford GW, Prouty MG, Newell SW, et al. Antimicrobial resistance genotypes and phenotypes from multidrug-resistant bacterial wound infection isolates in Cambodia. J Glob Antimicrob Resist. 2015;3(3):198-204.

Theuretzbacher U. Global antimicrobial resistance in Gram-negative pathogens and clinical need. Curr Opin Microbiol. 2017;39:106-12.

Antony SJ, Westbrook RS, Jackson JS, Heydemann JS, Nelson JL. Efficacy of Single-stage Revision with Aggressive Debridement Using Intra-articular Antibiotics in the Treatment of Infected Joint Prosthesis. Infect Dis (Auckl). 2015;8:17-23.

Martinez-Pastor JC, Vilchez F, Pitart C, Sierra JM, Soriano A. Antibiotic resistance in orthopaedic surgery: acute knee prosthetic joint infections due to extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. Eur J Clin Microbiol Infect Dis. 2010;29(8):1039-41.

Tseng WP, Chen YC, Yang BJ, Chen SY, Lin JJ, Huang YH, et al. Predicting Multidrug-Resistant Gram-Negative Bacterial Colonization and Associated Infection on Hospital Admission. Infect Control Hosp Epidemiol. 2017;38(10):1216-25.

Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004;350(14):1422-9.

Garica L. Collection, Transport, and Manipulation of Clinical Specimens and Initial Laboratory Concerns. 3 ed. 2010. Washington, DC: ASM Press; 2010.

York MK. Wound/Abscess and Soft Tissue Cultures. 3 ed. Aerobic Bacteriology, ed. D.L. Church. Vol. 1. 2010. Washington, DC: ASM Press; 2010.

CLSI, Performance standards for antimicrobial susceptibility testing: twenty first informational supplement (MIOO-S21). T.C.A.L.S. Institute, Editor. Wayne, PA. 2011.

Khan MS, ur Rehman S, Ali MA, Sultan B, Sultan S. Infection in orthopedic implant surgery, its risk factors and outcome. J Ayub Med Coll Abbottabad. 2008;20(1):23-5.

Ibtesam KA, Baghagho EA. Three months study of orthopedic surgical site infections in an Egyptian University hospital. Int J Infect Control. 2010;6(1):25-7.

Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013;56(1):1-25.

Burns TC, Stinner DJ, Mack AW, Potter BK, Beer R, Eckel TT, et al. Microbiology and injury characteristics in severe open tibia fractures from combat. J Trauma Acute Care Surg. 2012;72(4):1062-7.

Aggarwal VK, Higuera C, Deirmengian G, Parvizi J, Austin MS. Swab cultures are not as effective as tissue cultures for diagnosis of periprosthetic joint infection. Clin Orthop Relat Res. 2013;471(10):3196-203.

Costerton JW. New methods for the detection of orthopedic and other biofilm infections. FEMS Immunol Med Microbiol. 2011;61(2):133-40.

Zimmerli W. Orthopaedic device-associated infection. Clin Microbiol Infect. 2012;18(12):1160-1.

Bergin PF, Doppelt JD, Hamilton WG, Mirick GE, Jones AE, Sritulanondha S, et al. Detection of periprosthetic infections with use of ribosomal RNA-based polymerase chain reaction. J Bone Joint Surg Am. 2010;92(3):654-63.

Greenwood-Quaintance KE, Uhl JR, Hanssen AD, Sampath R. Diagnosis of prosthetic joint infection by use of PCR-electrospray ionization mass spectrometry. J Clin Microbiol. 2014;52(2):642-9.

Antony SJ. Extended-Spectrum Beta-Lactamase Infections in Orthopedic-Related Devices and Prosthetic Joints. Orthopedics. 2016;39(4):668-73.

de Breij A. Prevention of Staphylococcus aureus biomaterial-associated infections using a polymer-lipid coating containing the antimicrobial peptide OP-145. J Control Release. 2016;222:1-8.

Rajkumari N. Outcomes of surgical site infections in orthopedic trauma surgeries in a tertiary care centre in India. J Postgrad Med. 2014;60(3):254-9.

Mangram AJ. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20(4):250-78.

de Sanctis J. Complex prosthetic joint infections due to carbapenemase-producing Klebsiella pneumoniae a unique challenge in the era of untreatable infections. Int J Infect Dis. 2014;25:73-8.

Okeke IN. Antimicrobial resistance in developing countries. Part II: strategies for containment. Lancet Infect Dis. 2005;5(9):568-80.