wetenschapsdag 2023 | 87 Sessie 3a: Holl(t)en of Stilstaan x3 Auteurs J. Tausendfreund, H. Plasmeijer, D. Penning, E. Tanis, P. Joosse, T. Schepers Abstract titel Determination of pathogens in surgical site infections in ankle fractures and implications for empiric antibiotic treatment Background Surgical site infections (SSI) are the most common complication after surgery for ankle fractures. In this retrospective study we aimed to determine the pathogens cultured in SSI and their antimicrobial susceptibility patterns to give a recommendation for empiric therapy. In addition, empiric antibiotic regimen, culture collection and succession of treatment were identified. Methods Patients who underwent surgical treatment for an ankle fracture between 2015 and 2020 were included. Data were collected from electronic health records (EHR). Cases were selected on the occurrence of SSI and treatment strategies were retrieved from EHR to distinguish between superficial and deep SSI. The culture results and antimicrobial susceptibility patterns, empiric antibiotic regimen and culture collection were documented. Data on recurrence of infection, persisting wound defects and implant removal were collected as well. Results A total of 81 (9%) out of 931 patients developed an SSI, divided into 39 (48%) superficial SSI and 42 (52%) deep SSI. The swabs showed pathogens in 53 cases. The most common pathogens were Staphylococcus aureus, cultured in 11 (69%) superficial SSI and 23 (62%) deep SSI, and Enterobacter cloacae, cultured in 5 (31%) superficial SSI and 12 (32%) deep SSI. Higher frequencies of gram-negative bacteria and polymicrobial infections were found in deep SSI. Cultures were not collected in 16 (41%) superficial SSI and collected via superficial swabs in 14 (33%) deep SSI. Cultures were collected after the first dose of antibiotics in 15 (23%) SSI in total. Resistance to empiric antibiotics was found in 19 (36%) cases. In 21 (35%) patients superficial SSI treatment failed. Conclusion Our study found S. aureus and E. cloacae as most common pathogens in SSI in ankle fractures. It is recommended to aim empiric treatment at both gram-positive and gram-negative microorganisms in case of deep SSI. Furthermore, we recommend maintaining a low threshold for surgical debridement together with deep tissue samples.
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