Incidence and Risk Factors for colonization of Multidrug-Resistance Organisms (MDROs) among Patients Undergoing Elective Orthopedic Surgery at Thammasat University Hospital

BACKGROUND: There is limited data on incidence of MDROs colonization and outcome in patients undergoing elective orthopedic surgery. METHODS: We performed MDROs surveillance screening (swabs from nose, throat, groins, and rectum) in patients undergoing elective orthopedic surgery at the Thammasat University Hospital between March and August 2016. MDROs were defined as Gram-negative bacteria (GNB) possessing extended-spectrum β-lactamases (ESBLs), Carbapenem-resistant Enterobacteriaceae (CRE), and non-lactose fermenting GNB resistant to at least 3 antibiotic classes, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin resistant enterococci (VRE). MDROs were identified by the Vitek®2 automated system. Antimicrobial susceptibility testing (disk diffusion test) was performed using the CLSI Interpretive Guidelines. Incidence of MDROs colonization upon admission was determined. Patient’s clinical characteristics, risk factors for MDROs infection, procedure types and antibiotic prophylaxis were prospectively collected. Surgical sites infections (SSIs) and complications up to 6 months after surgery among the patients with and without MDROs colonization were compared. RESULTS: Of 384 swabs tested from 96 patients (median age, 58 years), ESBL-producing Escherichia coli (ESBL-E. coli) was identified in 31 rectal swabs (32.3%) and 7 groin swabs (7.3%). Seven patients (7.3%) were diagnosed with SSIs. A higher rate of SSIs was found among patients with ESBL-E. coli colonization (6/31, 19.4%) compared with patient without ESBL-E. coli colonization (1/65, 1.5%; P = 0.004, OR 15.4, 95% CI 1.7–356.3). From the multivariate logistic regression analysis, SSIs were significantly associated with ESBL-E.coli colonization (P = 0.009, adjusted OR 18.3, 95% CI 2.1–162.9). In addition, from the multivariate logistic regression analysis, ESBL-E.coli was a significantly risk factor associated with SSIs (6/7, 85.7%, P = 0.014, adjusted OR 16.5, 95% CI 1.8–153.4). CONCLUSION: We found a high incidence of ESBL-E. coli colonization and rate of SSIs in patients who had elective orthopedic surgery. These patients did not have any other risk factors for MDROs infection. Active screening for colonization of ESBL-producing pathogens may be necessary to guide appropriate antibiotic prophylaxis to reduce rates of SSIs. DISCLOSURES: All authors: No reported disclosures.