Articles | Volume 2, issue 2
J. Bone Joint Infect., 2, 73–76, 2017
J. Bone Joint Infect., 2, 73–76, 2017

Original full-length article 15 Jan 2017

Original full-length article | 15 Jan 2017

Which Orthopaedic Patients Are Infected with Gram-negative Non-fermenting Rods?

Omid Jamei1, Shpresa Gjoni2, Besa Zenelaj1, Benjamin Kressmann1,3, Wilson Belaieff1, Didier Hannouche1, and Ilker Uçkay1,3 Omid Jamei et al.
  • 1Orthopaedic Surgery Service
  • 2Division of General Medical Rehabilitation
  • 3Service of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Switzerland

Keywords: Orthopaedic infections, epidemiology, Gram-negative, non-fermenting rods, Pseudomonas aeruginosa

Abstract. Background: 1st and 2nd generation cephalosporins used for perioperative prophylaxis in orthopaedic surgery do not cover non-fermenting Gram-negative rods (NFR).

Methods: Epidemiological cohort study of adult patients operated for orthopedic infections between 2004 and 2014 with perioperative cefuroxim or vancomycin prophylaxis. Exclusion of polyneuropathic ischemic foot infections and septic bursitis cases.

Results: Of the total 1840 surgical procedures in the study, 430 grew Gram-negative pathogens (23%), of which 194 (11%) were due to NFR and 143 (8%) to Pseudomonas aeruginosa. Overall, 634 episodes (35%) involved orthopaedic implants (321 arthroplasties, 135 plates, 53 nails, and others). In multivariate analysis and group comparisons, especially preoperative antibiotic use (124/194 vs. 531/1456; p<0.01) was significantly associated with NFR.

Conclusions: Overall proportion of NFR oscillated between 9% and 13% among our orthopaedic infections. Variables associated with NFR were antibiotic use prior to hospitalization. The low infection rate of NFR following elective surgery and the community-based epidemiology, has led us to keep our standard perioperative prophylaxis unchanged.