Microbiological profile of patients with orthopedic implant-associated infection in the post-COVID period

Abstract

Background. The etiological structure of implant-associated infection and antibiotic resistance of pathogens are important when choosing empirical antibiotic therapy. COVID-19 pandemic and increased consumption of antibiotics by the population could provoke an increase in antibiotic resistance.The aim of the work. To compare the spectrum of leading pathogens of implantassociated infection in the pre- and post-Covid period and to assess antibiotic resistance.Materials and methods. A continuous retrospective study of biomaterial samples from traumatology and orthopedic patients with implant-associated infection was carried out for 2018–2019 and 2021–2022. The sample consisted of 548 microorganism strains (n = 237 and n = 317, respectively) in 442 cases of infectious complications. The antibiotic resistance of all isolated microorganisms, including those from microbial associations, was assessed.Results. The leading pathogen of monomicrobial implant-associated infection in both study periods was Staphylococcus epidermidis (33–37 %). In 2021–2022, the proportion of microbial associations increased (from 12.5 to 17.5 %; p = 0.147) with the appearance of fungi in the microbial landscape. In the post-Covid period, the increase in Staphylococcus aureus resistance to tetracycline and doxycycline was revealed; the isolation of methicillin-resistant strains among Staphylococcus aureus decreased from 4 cases (out of 187) to 3 (out of 232); 100 % sensitivity to rifampicin and co-trimoxazole was maintained. An increase in Staphylococcus epidermidis resistance to all tested antibiotics was detected (statistically significant increase in resistance to fluoroquinolones; p = 0.002–0.003) with the isolation of methicillin-resistant strains in 80.5% and 80.9% of cases, respectively. All staphylococcal isolates were susceptible to vancomycin and linezolid. Enterobacteriaceae representatives showed a decrease in resistance to carbapenems and an increase in resistance to co-trimoxazole; in Pseudomonas aeruginosa and Acinetobacter baumannii, there is an increase in resistance to carbapenems and fluoroquinolones. All gram-negative microorganisms were sensitive to colistin.Conclusion. The high frequency of isolation of methicillin-resistant staphylococci determines the choice of vancomycin for empirical therapy. Increasing resistance of staphylococci to fluoroquinolones may limit their use. Increasing resistance of gram-negative bacteria and a narrow spectrum of antibiotics acting on carbapenemase producers may reduce the effectiveness of therapy.