Pathogens and Shift of Resistance in Early Infections after Operative Fracture Fixation.

Surgical site infections (SSIs) remain a challenge for the healthcare system. During the last 30 years, the literature has shown an increase of gram-negative bacterial strains in multiple infectious sites and that cephalosporins have replaced penicillin as the gold standard in peri-operative antibiotic prophylaxis. This study aims to examine the recent bacterial spectrum in orthopedic early SSIs and to compare it with a historical cohort. Patients in a level 1 trauma center with an SSI within six weeks after open fixation of a fracture were analyzed in two adjacent periods from 2007 to 2012 (data pool 1; DP1) and 2013 to 2017 (data pool 2; DP2), retrospectively. The detected microbiologic pathogens and the associated resistograms from both time periods were compared. Six hundred eighty-one smear tests and respective pathogens from the wounds of 463 patients (mean age, 62.6 ± 20 years) with SSIs were analyzed. The following pathogens were found most frequent: (DP1, 20.6%; DP2, 26.3%), (DP1, 27.1%; DP2, 16.5%), (DP1, 13.7%; DP2, 11.1%), . (DP1, 3.0%; DP2, 5.3%), (DP1, 5.1%; DP2, 4.1%), (DP1, 3.7%; DP2, 2.5%). In DP2, there were lower primary early infection rates with than in DP1 (p = 0.002). In DP2, showed an oxacillin resistance in 90.6% and an increased resistance (79.8%; p = 0.069) to several classes of antibiotic agents compared to DP1. No bacterial shift toward gram-negative species was observed in this investigation. However, showed an increased antibiotic resistance in the more recent patient cohort. The incidence of SSIs with decreased substantially.