Diabetes Mellitus Influencing the Bacterial Species in Surgical Site Infections of Orthopedic Trauma Patients. Issue 1 (January 2022)

• Record Type: Journal Article
• Authors: Angeli, Rico; Lippmann, Norman; Rodloff, Arne C.; Fakler, Johannes K. M.; Behrendt, Daniel
• Is Part Of: Infectious diseases in clinical practice. Volume 30:Issue 1(2022)
• Publication Date: 2022-01
• Subjects: surgical site infection -- diabetes mellitus -- trauma surgery -- antimicrobial resistance -- antibiotic prophylaxis -- MRSA -- MRSE -- Enterococcus faecalis; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Periodicals; Electronic journals; 616.9
• DOI: 10.1097/IPC.0000000000001065
• Languages: English
• ISSNs: 1056-9103

Abstract

Abstract : Objective: Diabetes mellitus is a well-known risk factor for delayed wound healing and surgical site infections (SSIs). With the exception of urinary tract infections, information on changes in bacterial etiology and antimicrobial resistance patterns for patients with diabetics is rare. This study compared the prevalence of bacterial species and their antimicrobial resistance in patients with SSI and with or without diabetes mellitus. Methods: Patients with a postoperative SSI within 6 weeks after orthopedic surgery due to a fracture or joint injury (in a level 1 trauma center in Germany) were analyzed retrospectively for the time period of 2007 to 2012. Microbiological results were assessed by comparing the prevalence of bacterial species and minimal inhibitory concentration of 34 antimicrobial agents for both patient groups. Results: Three hundred three patients (female = 140, male = 163) were analyzed. Seventy nine (26.1%) of them had diabetes mellitus. Diabetic patients were older (mean age, 70.7 vs 60.1 years, P < 0.001) and more obese (48.1% vs 17.4%; odds ratio [OR], 4.40 [2.51–7.70], P < 0.001). Infection associated mortality was higher in the diabetes group (10.1% vs 2.7%; OR, 4.09 [1.37–12.20], P = 0.012). Most frequent isolates from wound specimen were Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Escherichia coli, and Pseudomonas aeruginosa . Enterococcus faecalis was more frequent in diabetic patients ( P = 0.030; OR, 1.89 [1.07–3.34]). There was no difference in resistance against cefuroxime and in the frequency of multidrug-resistant strains in both groups. Conclusions: Patients with diabetes mellitus and postoperative SSI showed a higher frequency of E. faecalis isolate. However, antibiotic prophylaxis with cephalosporins still seems to be effective in most cases. Abstract : Supplemental digital content is available in the text.