Prevalence of methicillin-resistant Staphylococcus aureus and other pathogens in pus samples of orthopedic department at a tertiary care hospital in Pakistan

  • Ashfaq Ahmed Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan https://orcid.org/0000-0001-7047-3100
  • Rizwan Akram Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan https://orcid.org/0000-0003-3207-5819
  • Saeed Ahmad Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
  • Atiq Uz Zaman Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
  • Naeem Ahmad Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
  • Shahzad Javed Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
  • Amer Aziz Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan https://orcid.org/0000-0002-1306-0956
Keywords: MRSA, orthopedics, prevalence, Staphylococcus aureus
Abstract viewed: 840 times
PDF downloaded: 636 times
HTML downloaded: 106 times
EPUB downloaded: 296 times

Abstract

BACKGROUND Orthopedic infections are difficult to manage. Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most dangerous and harmful bacteria and is difficult to eradicate because of its changing strains as well as sensitivity to different antibiotics. The main aim of this study was to determine the prevalence of pathogens, especially MRSA, associated with orthopedic wounds and their sensitivity to different antibiotics.

METHODS A prospective study was conducted from September 2015 to August 2016. Pus samples of 1,350 patients who presented at the out-patient department or admitted with a wound infection after an orthopedic intervention were taken with the help of culture swab and were sent for culture and sensitivity according to hospital protocol. Data analyses were made using the SPSS software, version 17 (IBM).

RESULTS Adults aged between 15 and 30 years were most affected, with 444 (32.9%) cases. Of the patients, 268 (19.9%) had negative cultures. Among the patients with positive cultures, the gram-positive cocci and gram-negative rods were 497 (36.8%) and 377 (27.9%), respectively. The most common pathogen was MRSA (240; 17.8%), followed by Escherichia coli and methicillin-sensitive S. aureus.

CONCLUSIONS Multiple pathogens are involved in patients having an orthopedic surgical intervention. The high occurrence of MRSA and E. coli has an increasing economic burden on patients because of these pathogens high resistance to antibiotics. Thus, proper preventive measures should be done to decrease the occurrence of such infections as well as their associated morbidity.

Downloads

Download data is not yet available.

References

  1. Ehrlich GD, Stoodley P, Kathju S, Zhao Y, McLeod BR, Balaban N, et al. Engineering approaches for the detection and control of orthopaedic biofilm infections. Clin Orthop Relat Res. 2005;(437):59-66. https://doi.org/10.1097/00003086-200508000-00011

  2. Uckay I, Hoffmeyer P, Lew D, Pittet D. Prevention of surgical site infections in orthopaedic surgery and bone trauma: state-of-the-art update. J Hosp Infect. 2013;84(1):5-12. https://doi.org/10.1016/j.jhin.2012.12.014

  3. Ju KL, Zurakowski D, Kocher MS. Differentiating between methicillin-resistant and methicillin-sensitive Staphylococcus aureus osteomyelitis in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. 2011;93(18):1693-701. https://doi.org/10.2106/JBJS.J.01154

  4. Stewart PS, Costerton JW. Antibiotic resistance of bacteria in biofilms. Lancet. 2001;358(9276):135-8. https://doi.org/10.1016/S0140-6736(01)05321-1

  5. Hickok NJ, Shapiro IM. Immobilized antibiotics to prevent orthopaedic implant infections. Adv Drug Deliv Rev. 2012;64(12):1165-76. https://doi.org/10.1016/j.addr.2012.03.015

  6. Trampuz A, Widmer AF. Infections associated with orthopedic implants. Curr Opin Infect Dis. 2006;19(4):349-56. https://doi.org/10.1097/01.qco.0000235161.85925.e8

  7. Puckett SD, Taylor E, Raimondo T, Webster TJ. The relationship between the nanostructure of titanium surfaces and bacterial attachment. Biomaterials. 2010;31(4):706-13. https://doi.org/10.1016/j.biomaterials.2009.09.081

  8. Periti P, Mini E, Mosconi G. Antimicrobial prophylaxis in orthopaedic surgery: the role of teicoplanin. J Antimicrob Chemother. 1998;41(3):329-40. https://doi.org/10.1093/jac/41.3.329

  9. Arciola CR, Montanaro L, Costerton JW. New trends in diagnosis and control strategies for implant infections. SAGE Publications Sage UK: London, England; 2011. https://doi.org/10.5301/IJAO.2011.8784

  10. Palmer M, Costerton W, Sewecke J, Altman D. Molecular techniques to detect biofilm bacteria in long bone nonunion: a case report. Clin Orthop Relat Res. 2011;469(11):3037-42. https://doi.org/10.1007/s11999-011-1843-9

  11. Murphy E, Spencer SJ, Young D, Jones B, Blyth MJ. MRSA colonisation and subsequent risk of infection despite effective eradication in orthopaedic elective surgery. J Bone Joint Surg Br. 2011;93(4):548-51. https://doi.org/10.1302/0301-620X.93B4.24969

  12. Campbell KA, Stein S, Looze C, Bosco JA. Antibiotic stewardship in orthopaedic surgery: principles and practice. J Am Acad Orthop Surg. 2014;22(12):772-81. https://doi.org/10.5435/JAAOS-22-12-772

  13. Dulon M, Haamann F, Peters C, Schablon A, Nienhaus A. MRSA prevalence in European healthcare settings: a review. BMC Infec Dis. 2011;11:138. https://doi.org/10.1186/1471-2334-11-138

  14. Vidhani S, Mehndiratta PL, Mathur MD. Study of methicillin resistant S. aureus (MRSA) isolates from high risk patients. Indian J Med Microbiol. 2001;19(2):13-6.

  15. Truong H, Shah SS, Ludmir J, Tawananana EO, Bafana M, Wood SM, et al. Staphylococcus aureus skin and soft tissue infections at a tertiary hospital in Botswana. S Afr Med J. 2011;101(6):413-6.

  16. Edmundson S, Hirpara K, Bennett D. The effectiveness of methicillin-resistant Staphylococcus aureus colonisation screening in asymptomatic healthcare workers in an Irish orthopaedic unit. Eur J Clin Microbiol Infect Dis. 2011;30(9):1063-6. https://doi.org/10.1007/s10096-011-1192-3

  17. Kelly J, O'Briain D, Walls R, Lee SI, O'Rourke A, Mc Cabe JP. The role of pre-operative assessment and ringfencing of services in the control of methicillin resistant Staphlococcus aureus infection in orthopaedic patients. Surgeon. 2012;10(2):75-9. https://doi.org/10.1016/j.surge.2011.01.008

  18. Tai CC, Nirvani AA, Holmes A, Hughes SP. Methicillin-resistant Staphylococcus aureus in orthopaedic surgery. Int Orthop. 2004;28:32-5. https://doi.org/10.1007/s00264-003-0505-2

  19. Roche SJ, Fitzgerald D, O'Rourke A, McCabe JP. Methicillinresistant Staphylococcus aureus in an Irish orthopaedic centre: a five-year analysis. J Bone Joint Surg Br. 2006;88(6):807-11. https://doi.org/10.1302/0301-620X.88B6.17042

  20. Kaur DC, Wankhede S. Biofilm formation and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus from wound infection. Asian Pac J Health Sci. 2014;1(4):322-28. https://doi.org/10.21276/apjhs.2014.1.4.5

  21. Chen X, Zhu D. Pathogens distribution of hospital infection and their drug resistance in Department of Orthopedics. Chinese Journal of Nosocomiology. 2008;(04):570-3.

  22. Kumar S, Joseph NM, Easow JM, Singh R, Umadevi S, Pramodhini S, et al. Prevalence and current antibiogram of Staphylococci isolated from various clinical specimens in a tertiary care hospital in Pondicherry. Internet J Microbiol. 2012;10(1).

  23. Gardete S, Aires-De-Sousa M, Faustino A, Ludovice AM, de Lencastre H. Identification of the first vancomycin intermediateresistant Staphylococcus aureus (VISA) isolate from a hospital in Portugal. Microb Drug Resist. 2008;14(1):1-6. https://doi.org/10.1089/mdr.2008.0816

  24. Economedes DM, Deirmengian GK, Deirmengian CA. Staphylococcus aureus colonization among arthroplasty patients previously treated by a decolonization protocol: a pilot study. Clin Orthop Relat Res. 2013;471(10):3128-32. https://doi.org/10.1007/s11999-013-2856-3

  25. Dar JA, Thoker MA, Khan JA, Ali A, Khan MA, Rizwan M, et al. Molecular epidemiology of clinical and carrier strains of methicillin resistant Staphylococcus aureus (MRSA) in the hospital settings of north India. Ann Clin Microbiol Antimicrob. 2006;5:22. https://doi.org/10.1186/1476-0711-5-22

Published
2019-10-04
How to Cite
1.
Ahmed A, Akram R, Ahmad S, Zaman AU, Ahmad N, Javed S, Aziz A. Prevalence of methicillin-resistant <em>Staphylococcus aureus</em&gt; and other pathogens in pus samples of orthopedic department at a tertiary care hospital in Pakistan. Med J Indones [Internet]. 2019Oct.4 [cited 2024Oct.10];28(3):252-7. Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/2634
Section
Clinical Research