OBJECTIVE This study investigated the recent status of the bacterial profile in

OBJECTIVE This study investigated the recent status of the bacterial profile in our institution and the concurrent antibiotic usage. The objectives of this study were to identify the current trends in the orthopaedic microbiological organisms and their antibiotic susceptibility and construct an antibiogram to identify patterns of drug resistance and assess the current guidelines of antibiotics use in Orthopaedic Surgery in this institution. METHODS We retrospectively reviewed 832 samples sent from orthopaedic surgery, including trauma, arthroplasty, sports, paediatrics, oncology interventions from Jan 2015 till Dec 2018. These samples included fluid, pus, tissue and bone specimens; surgically harvested under aseptic measures and sent for Gram Stain and Culture Sensitivity. All the specimens were subjected to an initial Gram Staining and cultured on MacConkey and Blood Agar culture media for 48 hours. Preliminary colony growths and subsequent antibiotic susceptibility were recorded into the standard CLSI M39A antibiogram chart The antibiotic stewardship program of our institution incorporated the multidisciplinary approach with Infectious disease, Orthopaedic Surgeon, Medical Intensivist and Infection Control nurse. Use of Preoperative antibiotics, their dosage and duration are defined and implemented by the antibiotic stewardship guidelines. RESULTS. Of 832 total samples collected, 651 samples (78.2%) yielded positive culture growth. The most common isolate was MRSA (309, 37.1%), followed by Enterobacter species (122, 14.6%). Other microorganisms included Coagulase Negative Streptococcus and MSSA (67, 8.1%), E. Coli (41, 4.9%), Pseudomonas Aeruginosa (31, 3.7%), Acinetobacter species (23, 2.8%) and miscellaneous (58, 7.0%). Most Gram-Positive species were resistant to Penicillin, cephalosporins, fluoroquinolones, macrolides and carbapenems, and only sensitive to Vancomycin, Linezolid and Extended Spectrum Penicillin/ Beta-lactamase. Most Gram-Negative Rods species were resistant to third generation cephalosporins, fluoroquinolones, tetracycline and only sensitive to carbapenems, colistin and Extended Spectrum Penicillin/ Beta lactamase. However, there were 27(3.2%) cases of MRSA even resistant to linezolid, vancomycin, daptomycin and 21(2.5) cases of Gram-negative rods resistant to carbapenem, colistin, Extended Spectrum Penicillin/ Beta lactamase, all having no antibiotic susceptibility. Of the 181(21.7%) samples that did not yield any culture growth, 68(8.2%) cases had clinically infected wound sites but unresponsive to treatment and previous history of prolonged oral and parenteral over the counter antibiotic usage for over 4 weeks. CONCLUSION. This study highlights the ever-changing pattern of microbiological infection in orthopaedics, with a significant rise to superbugs that are now resistant to most common broad-spectrum antibiotics. It illustrates the consequences of abuse of over-the-counter antibiotic prescribing and mandates for more rigorous antibiotic dispensing laws. These superbugs cause significant morbidity and require radical high potency antibiotics; and hence implies the urgent need to revise the current antibiotic practice to contain this rise of antibiotic resistance. KEYWORDS Antibiogram, Antibiotic Stewardship, Drug Resistance

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