Pre-operative Colonization by <i>Staphylococcus aureus and</i> Cephalosporin Non-susceptible Bacteria in Patients with Proximal Femoral Fractures

Bastos, Leonardo R.; Almeida, Mila M.; Marques, Elizabeth A.; Leão, Robson Souza

doi:10.1055/s-0041-1735546

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Revista Brasileira de Ortopedia

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Original Article • Rev. bras. ortop. 57 (05) • Sep-Oct 2022 • https://doi.org/10.1055/s-0041-1735546 copy

Pre-operative Colonization by Staphylococcus aureus and Cephalosporin Non-susceptible Bacteria in Patients with Proximal Femoral Fractures^* Work developed at the Microbiology, Immunology and Parasitology of the School of Medical Sciences of the Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil, and of the Hospital Geral de Fortaleza/Exército Brasileiro, Fortaleza, Ceará, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To estimate the frequency of Staphylococcus aureus and cephalosporin nonsusceptible bacteria colonization in patients with proximal femoral fracture during preoperative hospitalization.

Methods

Prevalence and incidence assessment in 63 hospitalized patients over 1 year. The median time of pretreatment hospitalization was 12 days. Samples were collected from the nostrils, groin skin and anal mucosa during the pretreatment hospitalization and were tested by the disc-diffusion technique.

Results

The hospital colonization incidence and the prevalence of positive results were 14.3 and 44.4% for S. aureus; 3.2 and 6.4% for meticillin-resistant S. aureus; 28.6 and 85.7% for meticillin-resistant coagulase-negative Staphylococcus; 28.6 and 61.9% for cefazolin nonsusceptible Enterobacteriaceae (KFNSE); and 20.6 and 28.6% for cefuroxime nonsusceptible Enterobacteriaceae (CXNSE). In addition, factors such as to the duration of the pretreatment hospitalization period, being non-walker before fracture, antimicrobial use, American Society of Anesthesiologists (ASA) 4 surgical risk, and previous hospitalization, were related to an increase in the incidence of hospital acquisition and prevalence of colonization by the evaluated strains. The prevalence of colonization by KFNSE was three times higher than by CXNSE on admission, and twice as high at the time of fracture treatment.

Conclusion

There was a high incidence of hospital colonization and prevalence of colonization by all strains studied, which may guide the indication of prophylactic measures for infection.

Keywords
carrier state; drug resistance; Enterobacteriaceae; femoral fractures; risk factors; Staphylococcus

	Hospital admission	Treatment date
Risk factor
Nonwalkers^a a Patients who moved only with the aid of a wheelchair or those who were bedridden prior to the occurrence of the fracture.	11 (17.5%)	11 (17.5%)
Diabetes mellitus	19 (30.2%)	19 (30.2%)
Hospitalization prior to fracture (12 months)	13 (20.6%)	13 (20.6%)
Use of antibiotics^b b Use of antibiotic before hospitalization (6 months), or during hospitalization and before fracture treatment.	20 (31.7%)	37 (58.73%)
Institutionalized^c c Patients hospitalized or residing in nursing homes, home hospitalization, or in hemodialysis treatment.	13 (20.6%)	13 (20.6%)
Bedsores^d d Presence of bedsores at hospital admission or acquired during hospitalization and before fracture treatment.	7 (11.1%)	13 (20.6%)
ASA 4^e e ASA, American Society of Anesthesiologists Physical Status score.	20 (31.75%)	20 (31.75%)
Bladder catheterization^f f Bladder catheterization or ICU stay occurring during hospitalization and before fracture.	0	13 (20.63%)
ICU stay^f f Bladder catheterization or ICU stay occurring during hospitalization and before fracture.	0	8 (12.7%)

Risk factor	S. aureus		MRCoNS		KFNSE		CXNSE
Risk factor	PR adm	PR ttmt	PR adm	PR ttmt	PR adm	PR ttmt	PR adm	PR ttmt
Nonwalkers^a a Patients who moved only with the aid of a wheelchair or those who were bedridden prior to the occurrence of the fracture.	1.68 [0.77–3.7] (0.19)	1.89 [1.15–3.11] (0.04)	1.14 [0.69–1.9] (0.45)	0.82 [0.57–1.2] (0.18)	0.79 [0.28–2.21] (0.46)	0.86 [0.48–1.53] (0.41)	0 (0.37)	0.95 [0.33–2.72] (0.62)
Diabetes mellitus	1.07 [0.48–2.4] (0.55)	1.09 [0.61–1.97] (0.49)	1.16 [0.74–1.8] (0.36)	0.98 [0.78–1.22] (0.65)	0.93 [0.43–2.02] (0.54)	0.91 [0.59–1.42] (0.44)	0.58 [0.07–4.84] (0.52)	1.47 [0.68–3.21] (0.25)
Hospitalization prior to fracture (12 months)	0.72 [0.25–2.11] (0.40)	0.84 [0.39–1.77] (0.43)	1.28 [0.82–2] (0.25)	0.98 [0.76–1.27] (0.60)	0.64 [0.22–1.85] (0.30)	0.99 [0.61–1.61] (0.61)	0 (0.30)	1.92 [0.89–4.14] (0.11)
Use of antibiotics^b b Use of antibiotic before hospitalization (6 months), or during hospitalization and before fracture treatment.	1.25 [0.58–2.7] (0.40)	1.48 [0.8–2.74] (0.14)	1.54 [1.03–2.28] (0.04)	1.29 [1.01–1.66] (0.02)	0.51 [0.2–1.31] (0.10)	0.67 [0.46–0.97] (0.03)	0.54 [0.06–4.51] (0.49)	0.56 [0.26–1.23] (0.12)
Institutionalized^c c Patients hospitalized or residing in nursing homes, home hospitalization, or in hemodialysis treatment.	2.53 [1.24–5.17] (0.06)	2.06 [1.28–3.33] (0.06)	0.56 [0.18–1.77] (0.21)	0.76 [0.43–1.35] (0.20)	0.47 [0.08–2.94] (0.34)	0.79 [0.35–1.81] (0.42)	0 (0.60)	1.90 [0.76–4.72] (0.22)
Bedsores^d d Presence of bedsores at hospital admission or acquired during hospitalization and before fracture treatment.	0.94 [0.27–3.24] (0.65)	1.05 [0.54–2.04] (0.57)	1.60 [1.08–2.36] (0.11)	1.22 [1.07–1.39] (0.11)	0.84 [0.25–2.87] (0.57)	0.57 [0.28–1.15] (0.05)	0 (0.54)	0.48 [0.13–1.83] (0.20)
ASA 4^e e ASA, American Society of Anesthesiologists Physical Status score.	1.25 [0.58–2.7] (0.39)	1.39 [0.81–2.39] (0.19)	1.22 [0.79–1.86] (0.28)	1.26 [1.08–1.47] (0.02)	0.67 [0.29–1.58] (0.25)	0.96 [0.62–1.46] (0.52)	1.43 [0.26–7.91] (0.51)	2.15 [1.01–4.58] (0.05)
Bladder catheterization^f f Bladder catheterization or ICU stay occurring during hospitalization and before fracture.	−	0.84 [0.39–1.77] (0.43)	−	1.22 [1.07–1.39] (0.11)	−	0.84 [0.49–1.45] (0.36)	−	1.1 [0.43–2.78] (0.55)
ICU stay^f f Bladder catheterization or ICU stay occurring during hospitalization and before fracture.	−	1.15 [0.54–2.44] (0.51)	−	1.20 [1.06–1.34] (0.27)	−	1.01 [0.57–1.8] (0.64)	−	1.96 [0.86–4.49] (0.15)

Risk factor	S. aureus	MRCoNS	KFNSE	CXNSE
Nonwalkers^a a Patients who moved only with the aid of a wheelchair or those who were bedridden prior to the occurrence of the fracture.	3.17 [1.07–9.38] (0.09)	0.34 [0.06–1.88] (0.09)	0.85 [0.32–2.25] (0.53)	1.28 [0.42–3.89] (0.47)
Diabetes mellitus	1.19 [0.35–4.06] (0.54)	0.82 [0.40–1.65] (0.43)	0.86 [0.39–1.90] (0.48)	1.91 [0.75–4.87] (0.15)
Hospitalization prior to fracture (12 months)	0.97 [0.24–3.96] (0.67)	0.72 [0.26–1.99] (0.41)	1.23 [0.58–2.6] (0.43)	2.97 [1.21–7.29] (0.03)
Use of antibiotics^b b Use of antibiotic before hospitalization (6 months), or during hospitalization and before fracture treatment.	5.54 [0.76–40.52] (0.04)	1.56 [0.91–2.67] (0.11)	0.62 [0.32–1.22] (0.16)	0.56 [0.22–1.46] (0.19)
Institutionalized^c c Patients hospitalized or residing in nursing homes, home hospitalization, or in hemodialysis treatment.	2.62 [0.57–12] (0.37)	0.72 [0.26–1.99] (0.41)	0.92 [0.3–2.88] (0.64)	2.60 [0.98–6.89] (0.12)
Bedsores^d d Presence of bedsores at hospital admission or acquired during hospitalization and before fracture treatment.	1.70 [0.52–5.61] (0.33)	1.56 [1.16–2.1] (0.44)	0.40 [0.11–1.45] (0.09)	0.32 [0.05–2.22] (0.18)
ASA 4^e e ASA, American Society of Anesthesiologists Physical Status score.	1.91 [0.61–5.99] (0.24)	1.82 [1.22–2.7] (0.03)	1.15 [0.57–2.32] (0.48)	2.59 [1.01–6.62] (0.05)
Bladder catheterization^f f Bladder catheterization or ICU stay occurring during hospitalization and before fracture.	1.50 [0.45–5.01] (0.39)	1.69 [1.2–2.4] (0.11)	0.53 [0.15–1.86] (0.23)	1.54 [0.56–4.2] (0.32)
ICU stay^f f Bladder catheterization or ICU stay occurring during hospitalization and before fracture.	2.64 [0.86–8.15] (0.14)	1.60 [1.17–2.18] (0.28)	0.92 [0.3–2.88] (0.64)	2.19 [0.79–6.06] (0.18)

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[1] Address for correspondence Robson Souza Leão, PhD, Departamento de Microbiologia, Imunologia e Parasitologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Avenida 28 de Setembro, S/N, Vila Isabel, Rio de Janeiro, RJ, Brazil (e-mail: robson.leao@uerj.br).