Analysis of microbiology and antibiotic susceptibility of perioperative urinary tract infection in patients undergoing hip or knee arthroplasty_West China Medical Journal

Authors：

CHEN Zhi , ZHOU Kai , WANG Duan ,  ZHOU Zongke , SHEN Bin , YANG Jing , KANG Pengde , PEI Fuxing

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZHOU Zongke, Email: zongke@126.com

Keywords：

Arthroplasty, hip, knee; Urinary tract infection; Bacterial sensitivity

DOI：

10.7507/1002-0179.201512159

Video：

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Objective To explore the microbiological etiology and antibiotic susceptibility of periopertive urinary tract infection (UTI) in patients undergoing hip or knee arthroplasty, so as to provide recommendations for antibiotic treatment. Methods A retrospective review was conducted for patients with perioperative UTI who underwent hip or knee arthroplasty between January 1st, 2013 and October 1st, 2015. Microbiological data and antibiotic susceptibility of bacteria were analyzed. Results A total of 117 strains of bacteria were identified, including 11 types of species. Among the organisms cultured, 86.3% (101 strains) were gram-negative bacteria, in which Escherichia coli was the most common causative organism (70.9%, 83 strains), followed by Klebsiella species (7.7%, 9 strains) and Proteus mirabilis (3.4%, 4 strains). And among the gram-positive bacteria detected, the proportion of Enterococcus faecalis and Feces Enterococcus was 6.8% (8 strains) and 3.4% (4 strains), respectively. The bacteria showed highly resistance to cephalosporins, quinolones and sulfonamides, but showed high sensitive to nitrofurantoin, carbopenems, the enzyme inhibitor complex and aminoglycoside antibiotics. Conclusions There is a diversity of bacteria involved in UTI, and the top 3 pathogens are Escherichia coli, Enterococcus faecalis and Klebsiella species. The resistance rate is high, and nitrofurantoin, amilacin, piperacillin-tazobactam, cefoperazone-sulbactam are the recommended antibiotics to treat the UTI, but the antibiotic should be adjusted according to susceptibility results.

Citation： CHEN Zhi, ZHOU Kai, WANG Duan, ZHOU Zongke, SHEN Bin, YANG Jing, KANG Pengde, PEI Fuxing. Analysis of microbiology and antibiotic susceptibility of perioperative urinary tract infection in patients undergoing hip or knee arthroplasty. West China Medical Journal, 2017, 32(9): 1387-1390. doi: 10.7507/1002-0179.201512159 Copy

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2.	Ridgeway S, Wilson J, Charlet A, et al. Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg Br, 2005, 87(6): 844-850.
3.	Pitout JD. Extraintestinal pathogenic Escherichia coli: an update on antimicrobial resistance, laboratory diagnosis and treatment. Expert Rev Anti Infect Ther, 2012, 10(10): 1165-1176.
4.	Nicolle LE, Bradley S, Colgan R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis, 2005, 40(5): 643-654.
5.	Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis, 2011, 52(5): e103-e120.
6.	赵静, 陈光辉, 王山梅. 尿路感染患者病原菌分布及耐药性分析. 中华实用诊断与治疗杂志, 2014, 28(1): 103-104.
7.	Cordero-Ampuero J, de Dios M. What are the risk factors for infection in hemiarthroplasties and total hip arthroplasties?. Clin Orthop Relat Res, 2010, 468(12): 3268-3277.
8.	Otermin I, Rivero M, Hidalgo A. Is it necessary to delay or to put off surgery in the case of possible asymptomatic bacteriuria and orthopaedic surgery with implants?. Enferm Infec Microbiol Clin, 2009, 27(4): 252-253.
9.	Linhares I, Raposo T, Rodrigues A, et al. Frequency and antimicrobial resistance patterns of bacteria implicated in community urinary tract infections: a ten-year surveillance study (2000-2009). BMC Infect Dis, 2013, 13(1): 19.
10.	乔庐东, 陈山, 杨勇, 等. 国内不同类型下尿路感染患者尿路病原菌构成及药敏分析的多中心研究. 中华泌尿外科杂志, 2015, 36(9): 690-693.
11.	尿路感染诊断与治疗中国专家共识编写组. 尿路感染诊断与治疗中国专家共识(2015版)——尿路感染抗菌药物选择策略及特殊类型尿路感染的治疗建议. 中华泌尿外科杂志, 2015, 36(4): 245-248.
12.	Pickard R, Bartoletti R, Bjerklund-Johansen TE, et al. European Association of Urology 2015. Guidelines on urological infections. Hactahobn, 2015, 3(13): 47-58.
13.	张原琪, 黄里, 刘燕. 尿路感染病原菌分布及耐药性分析. 中华医院感染学杂志, 2011, 21(13): 2852-2854.
14.	Lai B, Zheng B, Li Y, et al. In vitro susceptibility of Escherichia coli strains isolated from urine samples obtained in mainland China to fosfomycin trometamol and other antibiotics: a 9-year surveillance study (2004-2012). BMC Infect Dis, 2014, 14(1): 66.
15.	Gupta K, Bhadelia N. Management of urinary tract infections from multidrug-resistant organisms. Infect Dis Clin North Am, 2014, 28(1): 49-59.
16.	吴泽才, 吴少群, 向成玉. 2006-2010 年尿路感染病原菌分布及耐药性分析. 中华医院感染学杂志, 2012, 22(6): 1296-1299.

1. Iorio R, Whang W, Healy WL, et al. The utility of bladder catheterization in total hip arthroplasty. Clin Orthop Relat Res, 2005(432): 148-152.
2. Ridgeway S, Wilson J, Charlet A, et al. Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg Br, 2005, 87(6): 844-850.
3. Pitout JD. Extraintestinal pathogenic Escherichia coli: an update on antimicrobial resistance, laboratory diagnosis and treatment. Expert Rev Anti Infect Ther, 2012, 10(10): 1165-1176.
4. Nicolle LE, Bradley S, Colgan R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis, 2005, 40(5): 643-654.
5. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis, 2011, 52(5): e103-e120.
6. 赵静, 陈光辉, 王山梅. 尿路感染患者病原菌分布及耐药性分析. 中华实用诊断与治疗杂志, 2014, 28(1): 103-104.
7. Cordero-Ampuero J, de Dios M. What are the risk factors for infection in hemiarthroplasties and total hip arthroplasties?. Clin Orthop Relat Res, 2010, 468(12): 3268-3277.
8. Otermin I, Rivero M, Hidalgo A. Is it necessary to delay or to put off surgery in the case of possible asymptomatic bacteriuria and orthopaedic surgery with implants?. Enferm Infec Microbiol Clin, 2009, 27(4): 252-253.
9. Linhares I, Raposo T, Rodrigues A, et al. Frequency and antimicrobial resistance patterns of bacteria implicated in community urinary tract infections: a ten-year surveillance study (2000-2009). BMC Infect Dis, 2013, 13(1): 19.
10. 乔庐东, 陈山, 杨勇, 等. 国内不同类型下尿路感染患者尿路病原菌构成及药敏分析的多中心研究. 中华泌尿外科杂志, 2015, 36(9): 690-693.
11. 尿路感染诊断与治疗中国专家共识编写组. 尿路感染诊断与治疗中国专家共识(2015版)——尿路感染抗菌药物选择策略及特殊类型尿路感染的治疗建议. 中华泌尿外科杂志, 2015, 36(4): 245-248.
12. Pickard R, Bartoletti R, Bjerklund-Johansen TE, et al. European Association of Urology 2015. Guidelines on urological infections. Hactahobn, 2015, 3(13): 47-58.
13. 张原琪, 黄里, 刘燕. 尿路感染病原菌分布及耐药性分析. 中华医院感染学杂志, 2011, 21(13): 2852-2854.
14. Lai B, Zheng B, Li Y, et al. In vitro susceptibility of Escherichia coli strains isolated from urine samples obtained in mainland China to fosfomycin trometamol and other antibiotics: a 9-year surveillance study (2004-2012). BMC Infect Dis, 2014, 14(1): 66.
15. Gupta K, Bhadelia N. Management of urinary tract infections from multidrug-resistant organisms. Infect Dis Clin North Am, 2014, 28(1): 49-59.
16. 吴泽才, 吴少群, 向成玉. 2006-2010 年尿路感染病原菌分布及耐药性分析. 中华医院感染学杂志, 2012, 22(6): 1296-1299.

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Analysis of microbiology and antibiotic susceptibility of perioperative urinary tract infection in patients undergoing hip or knee arthroplasty

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