The microbiology of long bone fracture-related infections (LB-FRIs) in low and middle-income countries remains poorly described. Herein, we determine the microbiological profile, antimicrobial resistance patterns, and host factors associated with LB-FRIs in a South African orthopaedic trauma cohort. This multi-centre retrospective cohort study included adult patients (> 18 years) with confirmed LB-FRIs. We employed STATA 18 statistical software Release 18. College Station, TX: Stata Corp LLC for descriptive statistics, univariate and multivariate analyses, which identified associations between host factors and microbiological profiles. The study cohort comprised 115 patients, yielding 128 microbiological isolates. Gram-negative organisms predominated 57.0% (73/128), led by Pseudomonas aeruginosa 34.3% (44/128), sensitive to ciprofloxacin 75.0% (33/44) and piperacillin-tazobactam 68.2% (30/44). Gram-positive isolates comprised 35.2% (45/128), including Staphylococcus aureus (18.0%, 23/128), and the susceptibility to cloxacillin was 56.0% (13/23). In our univariate analysis, increased age (odds ratio, OR = 1.02; 95% confidence interval, CI 1.01-1.03; p < 0.001), HIV positivity (OR 3.33; CI 1.33–8.30; p=0.01), and male sex (OR 3.16; CI 1.81–5.58; p < 0.001) were significantly associated with monomicrobial isolation. In this cohort from South Africa, LB-FRIs were predominantly gram-negative, specifically P. aeruginosa, which was sensitive to ciprofloxacin and piperacillin-tazobactam. Age, male sex, and HIV status influenced microbial distribution, but only male sex remained independently associated which likely reflects known epidemiological patterns rather than intrinsic biological susceptibility. Ongoing regional surveillance and larger prospective studies are warranted to guide empirical therapy and optimise outcomes in resource-limited settings. level 4
Nokwe et al. (Sun,) studied this question.