Incidence and outcomes for colonization of multidrug-resistance organisms (MDROs) among patients undergoing elective orthopedic surgery.

OBJECTIVE

To evaluate the incidence, risk factors, and outcomes associated with multidrug-resistant organisms (MDROs) colonization in patients undergoing elective orthopedic surgery at the Thammasat University Hospital.

METHODS

We conducted a prospective MDROs surveillance screening (swabs from the nose, throat, groin, and rectum) in patients undergoing orthopedic surgery. MDROs were defined as extended-spectrum β-lactamase (ESBL)-producing Gram-negative bacteria (GNB), carbapenem-resistant Enterobacterales, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci. The incidence of MDROs colonization, risk factors, and outcomes including surgical site infections (SSIs) were assessed. Postoperative SSIs were compared between patients with and without MDROs colonization.

RESULTS

Of 384 swabs tested from 96 patients, ESBL-producing Escherichia coli was identified in 38 isolates (31 rectal swabs and 7 groin swabs) from 31 patients (32.3%). Only one patient had a history of admission within the previous year. Majority of procedures involved prosthetic implantation (77.1%) including total knee arthroplasty (30.2%). Seven patients (7.3%) developed SSIs without microbiological confirmation. The incidence of SSIs was higher among patients with ESBL-producing E. coli colonization compared to patients without colonization (6/31, 19.4% vs. 1/65, 1.5%; P = .004; odds ratio, 15.36; 95% CI 1.7-356.3). From the multivariate logistic regression analysis, preoperative ESBL-producing E. coli colonization was associated with SSIs (P = .014, adjusted odds ratio 16.53, 95% CI 1.78-153.44).

CONCLUSION

Preoperative ESBL-producing E. coli colonization was common among patients undergoing orthopedic surgery and possibly increased risk of SSIs. Further studies for multidrug-resistant GNB screening, surgical outcomes, and antibiotic prophylaxis modification should be considered in endemic regions.