Which Orthopaedic Patients Are Infected with Gram-negative Non-fermenting Rods?

Abstract

<b><i>Background</i></b> : 1^st and 2^nd generation cephalosporins used for perioperative prophylaxis in orthopaedic surgery do not cover non-fermenting Gram-negative rods (NFR). <b><i>Methods:</i></b> Epidemiological cohort study of adult patients operated for orthopedic infections between 2004 and 2014 with perioperative cefuroxim or vancomycin prophylaxis. Exclusion of polyneuropathic ischemic foot infections and septic bursitis cases. <b><i>Results:</i></b> Of the total 1840 surgical procedures in the study, 430 grew Gram-negative pathogens (23%), of which 194 (11%) were due to NFR and 143 (8%) to <i>Pseudomonas aeruginosa</i>. Overall, 634 episodes (35%) involved orthopaedic implants (321 arthroplasties, 135 plates, 53 nails, and others). In multivariate analysis and group comparisons, especially preoperative antibiotic use (124/194 vs. 531/1456; <i>p</i><0.01) was significantly associated with NFR. <b><i>Conclusions:</i></b> Overall proportion of NFR oscillated between 9% and 13% among our orthopaedic infections. Variables associated with NFR were antibiotic use prior to hospitalization. The low infection rate of NFR following elective surgery and the community-based epidemiology, has led us to keep our standard perioperative prophylaxis unchanged.