Relationship between skin and urine colonization and surgical site infection in the proximal femur fracture: a prospective study

• Published in: International orthopaedics Vol. 44; no. 6; pp. 1031 - 1035
• Main Authors: Cuchí, Eva, García, Lucía Gómez, Jiménez, Elena, Haro, Daniel, Castillón, Pablo, Puertas, Laura, Matamala, Alfredo, Anglès, Francesc, Pérez, Josefa
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2020
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; Antibiotic Prophylaxis; Escherichia coli; Female; Femoral Fractures - surgery; Femur; Hip Fractures - surgery; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Orthopedics; Prospective Studies; Surgical Wound Infection - diagnosis; Surgical Wound Infection - epidemiology; Surgical Wound Infection - microbiology; Antibiotic prophylaxis; Surgical site infection; Microbiota; Elderly population; Proximal femur fracture
• ISSN: 0341-2695; 1432-5195
• DOI: 10.1007/s00264-020-04525-w

Purpose
Antibiotic prophylaxis is routinely used in the surgical management of proximal femur fractures
.
The role of bacterial colonization of the skin and urine in the development of deep surgical site infections (SSI) is yet to be elucidated. This study aimed to evaluate the role of previous skin and urine colonization in the development of deep SSI after a proximal femoral fracture surgery.
Methods
We conducted a prospective observational study in 326 patients > 64 years old, who were scheduled to surgery. Cultures from skin samples of the surgical site and from urine were performed prior to the procedure, and cefazoline was administered as prophylaxis.
Results
Skin microbiota was isolated in 233 (71.5%) cases; 8 (2.5%) samples were positive for other bacteria, and 85 (26%) were negative. Of 236 urine samples, 168 were negative or contaminated (71.2%), and 68 (28.8%) were positive, being 58/236 for
Enterobacterales
(24.6%). Acute deep SSI were diagnosed in nine out of 326 patients (2.7%), and two (22%) were infected by Gram-negative bacilli. Of the 9 cases, normal skin microbiota was isolated in 7 (78%), and the remaining two were negative. Seven cases had negative or contaminated urine cultures, and the one with
E. coli
did not correlate with SSI bacteria.
Conclusion
In our elderly hip fracture population, most patients harbored normal skin microbiota, and
Enterobacterales
urine cultures were positive in one-quarter of cases. There was no relationship between skin colonization, urine culture, and deep SSI. We therefore do not believe that our patients would benefit from modifying the current antibiotic prophylaxis.