Features of the choice of antibiotics for the treatment of orthopedic infection caused by Gram-positive pathogens, based on the results of 12 years of follow-up (Part 2 - fluoroquinolones, sulfonamides, tetracyclines, lincosamides, fosfomycin)

Introduction: Infection of the surgical area occurs in 1.5-1.6% of cases after endoprosthetics of large hip joints, and Gram–positive microorganisms are the most common causative agents of bone and joint infection (more than 70% of cases). Choosing antibacterial drugs for the treatment of patients with orthopedic infection is not an easy task for clinicians. Preference should be given to bactericidal drugs with antibiotic film activity, good penetration into bone tissue and activity against MRSE, MRSA. Objective: to substantiate the choice of a drug for empirical antibacterial therapy based on the results of an analysis of the dynamics of sensitivity to antibacterial drugs of leading Gram-positive bacteria isolated from patients with orthopedic infection from 2011 to 2022. Materials and methods: The materials and methods of this study are described in detail in the first part of the article. Results: More than 75% of MRSA strains and more than 50% of MRSE strains demonstrated resistance to fluoroquinolones. Over the 12 years of follow-up, our center has seen a decrease in the proportion of Staphylococcus spp. strains resistant to co-trimoxazole. At the same time, the drug is more active against S. aureus and methicillin-sensitive strains than against S.epidermidis and MR strains, respectively. The local monitoring data in our center demonstrate the activity of fosfomycin against more than 90% of staphylococci. In general, the average proportion of MRSA strains resistant to this drug was 5.8%, MRSE 7.7%, and MSSE 7%. The proportion of clindamycin-resistant MSSAS increased from 1.5% to 12% and averaged 4.4%. At the same time, the incidence of clindamycin-resistant MRSA varied between 39-60% with a tendency to decrease to 48% by the end of the follow-up period. Conclusion: in this article, we considered broad-spectrum antibiotics that can be used to treat infections caused by Gram-positive microorganisms (fluoroquinolones, sulfonamides, tetracyclines, lincosamides, fosfomycin) .Currently, broad-spectrum antibiotics cannot be recommended for empirical antibacterial therapy. The first part of the article was devoted to drugs with a narrow spectrum of action. The results of the study can be taken into account to determine the schemes of empirical antibacterial therapy in the departments of traumatology and orthopedics.