Discussing the appropriateness of antimicrobial treatment and multidrug-resistant organisms: a six-month flash insight on infections occurring in the Orthopedics department

Introduction Background/Rationale Increasing numbers of infections from multi-drug-resistant organisms constitute a rising worldwide emergency. Hospital wards, such as the Orthopaedic Department, are mostly involved. The presence of an implant increases the risk for an infection because its local susceptibility for bacteria adherence is high. The route of infection can be exogenous, haematogenous, or contiguous spread. Periprosthetic joint infection (PJI) is one of the most challenging and frequent complications after lower-extremity joint (hip and knee) arthroplasty. Several risk factors have been described for its development. In case on internal fixation the risk of infection depends on the exposure of the fracture and its type (Open Fracture Classification according to Gustilo et al). As a rule, all microorganisms can cause PJI. However, staphylococci are the most commonly isolated microorganisms in acute and chronic PJI. In case of open fractures with exposed bone, a polymicrobial flora contaminates the wound, β lactam-resistant gram-negative bacilli such as Enterobacter spp., nonfermenters, and anaerobes may play a more significant role than in those with closed fracture. A timely correct antimicrobial prophylaxis reduce postoperative infection but a limited drug choice options and costs make a pondered use of antibiotic therapy mandatory. Objectives The main goal is to ponder the present antibiotic stewardship strategy applied in the ward under observation, discussing its appropriateness in infection control.