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.