Epidemiologic Correlation and Drug Resistance Analysis of Pathogenic Bacteria in Different Open Limb Injury External Conditions

• Published in: Orthopaedic surgery Vol. 14; no. 8; pp. 1703 - 1714
• Main Authors: Xie, Bang‐lin, Guo, Run‐sheng, Liang, Wen, Yang, Xiao‐wei, Xu, Jia‐Qiang, Wan, Li‐jun, Yao, Wen‐ye, Yi, Zhi, Hu, Ni‐ya, Zhang, Bin
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01-08-2022; John Wiley & Sons, Inc; Wiley
• Subjects: Apparent temperature; Bacteria; Bone surgery; Climate change; Clinical; Drug resistance; Epidemiology; Gender; Gram-negative bacteria; Gram-positive bacteria; Hospitals; Humidity; Infection; Infectious diseases; Injuries; Laboratories; Microorganisms; Nosocomial infections; Open injury of limbs; Orthopedics; Pathogenic bacteria; Pathogens; Precipitation; Rain; Relative humidity; Statistical analysis; Trauma; United States > US; China
• ISSN: 1757-7853; 1757-7861
• DOI: 10.1111/os.13203

Objective
To study the epidemiological correlation and drug resistance of external factors of infection caused by open injury of limbs to pathogens.
Methods
This experiment is a retrospective study. We took the geographical location and climate of Nanchang, Jiangxi Province, China as the background, analyzed 2017 strains of pathogens from 1589 patients with limb trauma infection in a University Affiliated Hospital from 2012 to 2017. Patients were divided into three groups according to the type of incision: I, In‐hospital infection of clean limb incision, II, In‐hospital infection with open injury, III, Community infection with open injury of the limb. Groups II and Groups III were divided into six subgroups according to the causes of trauma, including: accidents from non‐motor vehicles, machinery, cutting/piercing, pedestrian injuries, struck by/against, pedal cycles, and other injuries. We found eight common pathogens of orthopedic infection, which were mainly divided into Gram‐positive bacteria (G+, mainly including Staphylococcus) and Gram‐negative bacteria (G‐, mainly Enterobacteriaceae). The relationship between main pathogens and damage mechanism, apparent temperature and relative humidity was discussed in this study. SPSS v22.0 was used for statistical analysis of the data. Friedman's two‐way ANOVA was used to analyze the difference between the injury mechanism and incidence of pathogenic bacteria. Linear regression was used to determine the trend between the incidence of major pathogens and seasonal temperature and humidity. The level of significance was set as P < 0.05.
Results
There was no significant difference in the distribution of pathogens between Groups II and Groups III (P>0.05). The drug resistance of Groups III was significantly higher than that of Groups II and Groups I. G+ bacteria were resistant to cephalosporin, ceftriaxone and other cephalosporins and erythromycin and other macrolides. They were sensitive to vancomycin and linezolid. G‐ were resistant to the first‐ and the second‐generation cephalosporins, including cefotetan and cefazolin, and ampicillin and other penicillins, while they were sensitive to third‐generation cephalosporins, such as ceftazidime, as well as to levofloxacin and other quinolones, meropenem, and other beta‐lactamases. The correlation between the injury mechanism and infection of pathogenic bacteria was not significant. The monthly average apparent temperature and relative humidity were correlated with the infection rate of pathogenic bacteria.
Conclusion
In open injury of extremities, apparent temperature and relative humidity is an important risk factor for infection by pathogenic bacteria and the drug resistance of pathogenic bacteria in out‐of‐hospital infection was lower than that of hospital infection.
Under different trauma mechanisms, the resistance of G‐ and G+ to common antibiotics in the three groups，“CTT” cefotetan, “KZ” cefazolin, “Lev” levofloxacin, “tobramycin,” caz “ceftazidime,” gen “gentamicin,” SXT “compound sulfamethoxazole,” IPM “imipenem. “Am” ampicillin, “P/T” piperacillin/tazobactam.