Antibiotic treatment practice for multidrug-resistant bacteria in deep surgical wound Infections – A retrospective analysis from the trauma registry

Objectives: To evaluate the orthopaedic surgical deep wound infections, antibiotic treatment practices, and multidrug-resistant bacteria. Methodology: Data on deep surgical site wound infections in patients treated at a tertiary care hospital were analyzed retrospectively from a single-center prospective trauma registry between July 2015 to July 2022. Patients with lower limb trauma-fractures were included irrespective of age and gender. Wound/blood cultures, C-reactive protein, WBC, and neutrophil counts were evaluated before and after antibiotic and surgical treatments. The Wilcoxon signed rank test compared WBC counts before and after treatment. Results: Of the total 764 enrolled patients, 46 (6%) developed deep surgical wound infections. Of 46 cases, four had missing information on investigations and were excluded from detailed analysis. Of the 42 remaining cases, there was a significant decrease in the WBC counts post-antibiotic treatment (z=-4.49, p<0.001). After several antibiotics and surgical interventions, 27 (64.3%) cases remained unresolved, indicating multi-drug-resistant bacterial infection. Staphylococcus aureus 18 (19.14%), Enterococcus species 12 (12.8%), Escherichia coli 10 (10.63%), Acinetobacter species 10 (10.63%), and Staphylococcus species 9 (9.6%) were the most common bacteria isolated from cultures. Frequently used antibiotics were Ciprofloxacin, Clindamycin, Gentamicin, Cephalosporines, Vancomycin, Carbapenems, and Piperacillin/tazobactam. Conclusion: The results identified common deep surgical wound infection isolates. More than half of the infections do not respond even after aggressive antibiotic and surgical treatment. For unresolved cases within a two week time, detailed investigations and an appropriate antibiotic selection are essential by matching the most recent effective antibiotics reports for that bacterial isolate and the culture sensitivity report.