{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T13:54:22Z","timestamp":1762005262825,"version":"build-2065373602"},"reference-count":28,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2020,12,23]],"date-time":"2020-12-23T00:00:00Z","timestamp":1608681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: The risk of healthcare-associated infections (HAIs) in surgical wards remains closely related to the type of surgery and procedures performed on patients. Those factors also condition the risk of various forms of clinical infections, especially urinary tract infections (UTIs). UTIs are most frequently (70\u201380% of cases) caused by the use of bladder catheter in the perioperative period. The aim of this study was to perform an epidemiological and microbiological analysis of UTIs in orthopedic patients, with an emphasis on multidrug-resistant (MDR) micro-organisms. Methods: The study was conducted in a 38-bed Department of Orthopedic-Traumatic Surgery in Sosnowiec, Poland. 5239 patients, operated on in 2013\u20132015, were included in the study. The urinary catheter use rate was 30.7%. Laboratory-based study used the UTI definition of the HAI-Net program. A micro-organism was declared MDR if it was resistant to at least one antibiotic from three or more groups of antibacterial drugs, and extensively drug-resistant (XDR) if it was sensitive to antibiotics from no more than two groups of drugs. Results: The UTI incidence was 3.2% (168 cases), the CA-UTI incidence density was 9.6\/1000 catheter days. The highest risk of UTI was found in patients aged 75 or older. Monomicrobial cultures were detected in 163 specimens (78% of all microbiologically confirmed UTIs). Gram-negative flora prevailed among the micro-organisms, the predominantly isolated Enterobacteriaceae being Escherichiacoli and Klebsiellapneumoniae. In 16 patients (7.7% of microbiologically confirmed UTIs), yeast infection was confirmed. Isolated micro-organisms were fully sensitive to carbapenems. Gram-negative bacilli showed the lowest sensitivity to extended substrate spectrum penicillins and fluoroquinolones (37\u201364%), as well as to trimethoprim-sulfamethoxazole (50%). The MDR prevalence was 24.4%. Conclusions: The presented data indicates that UTIs are a significant problem in the studied population, so is antimicrobial resistance, especially to quinolones, and extended-spectrum cephalosporins, which are often used as first-line therapy. To tackle the problem of high UTI incidence and MDR prevalence, reducing the UTI risk factors should be prioritized.<\/jats:p>","DOI":"10.3390\/antibiotics10010007","type":"journal-article","created":{"date-parts":[[2020,12,23]],"date-time":"2020-12-23T12:19:51Z","timestamp":1608725991000},"page":"7","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Multidrug-Resistant Micro-Organisms Associated with Urinary Tract Infections in Orthopedic Patients: A Retrospective Laboratory-Based Study"],"prefix":"10.3390","volume":"10","author":[{"given":"Grzegorz","family":"Zi\u00f3\u0142kowski","sequence":"first","affiliation":[{"name":"Sosnowiec Medical College, Wojska Polskiego 6 Str., 41-200 Sosnowiec, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iwona","family":"Paw\u0142owska","sequence":"additional","affiliation":[{"name":"Division of Microbiology and Epidemiology, St. Barbara Specialised Regional Hospital No. 5, Medyk\u00f3w 1 Square, 41-200 Sosnowiec, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Micha\u0142","family":"Stasiowski","sequence":"additional","affiliation":[{"name":"Clinical Department of Anaesthesiology and Intensive Therapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland"},{"name":"Department of Anaesthesiology and Intensive Therapy, St. Barbara\u2019s Memorial Regional Hospital in Sosnowiec, Plac Medyk\u00f3w 1, 41-200 Sosnowiec, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Estera","family":"Jachowicz","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine Jagiellonian University Medical College, 31-121 Krak\u00f3w (Cracow), Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0756-1639","authenticated-orcid":false,"given":"Jadwiga","family":"W\u00f3jkowska-Mach","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine Jagiellonian University Medical College, 31-121 Krak\u00f3w (Cracow), Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomasz","family":"Bielecki","sequence":"additional","affiliation":[{"name":"Department of Orthopedics of the Faculty of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,12,23]]},"reference":[{"key":"ref_1","first-page":"162","article-title":"Urinary Tract Infection after Total Hip Arthroplasty: A Retrospective Cohort Study","volume":"29","author":"Gossett","year":"2020","journal-title":"J. Surg. Orthop. Adv."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Ma, Y., and Lu, X. (2019). Indwelling catheter can increase postoperative urinary tract infection and may not be required in total joint arthroplasty: A meta-analysis of randomised controlled trial. BMC Musculoskelet. Disorder, 20.","DOI":"10.1186\/s12891-018-2395-x"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Parker, V., Giles, M., Graham, L., Suthers, B., Watts, W., O\u2019Brien, T., and Searles, A. (2017). Avoiding inappropriate urinary catheter use and catheter-associated urinary tract infection (CAUTI): A pre-post control intervention study. BMC Health Serv. Res., 17.","DOI":"10.1186\/s12913-017-2268-2"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/2047-2994-3-23","article-title":"Catheter associated urinary tract infections","volume":"3","author":"Nicolle","year":"2014","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Thakker, A., Briggs, N., Maeda, A., Byrne, J., Davey, J.R., and Jackson, T.D. (2018). Reducing the rate of post-surgical urinary tract infections in orthopaedic patients. BMJ Open Qual., 7.","DOI":"10.1136\/bmjoq-2017-000177"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1038\/nrmicro3432","article-title":"Urinary tract infections: Epidemiology, mechanisms of infection and treatment options","volume":"13","author":"Walker","year":"2015","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Paw\u0142owska, I., Zi\u00f3\u0142kowski, G., W\u00f3jkowska-Mach, J., and Bielecki, T. Can surgical site infections be controlled through microbiological surveillance? A three-year laboratory-based surveillance at an orthopaedic unit, retrospective observatory study. Int. Orthop., 2019.","DOI":"10.1007\/s00264-019-04298-x"},{"key":"ref_8","unstructured":"ECDC (2020, January 23). Surveillance of Healthcare-Associated Infections and Prevention Indicators in European Intensive Care Units HAI-Net ICU Protocol. Available online: https:\/\/ecdc.europa.eu\/sites\/portal\/files\/documents\/HAI-Net-ICU-protocol-v2.2_0.pdf."},{"key":"ref_9","unstructured":"EUCAST (2020, January 23). Guideline for the Detection of Resistance Mechanisms and Specific Resistances of Clinical and\/or Epidemiological Importance. Available online: http:\/\/www.eucast.org\/resistance_mechanisms\/."},{"key":"ref_10","unstructured":"EUCAST (2020, January 23). Clinical Breakpoints\u2014Breakpoints and Guidance. Available online: http:\/\/www.eucast.org\/clinical_breakpoints."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1111\/j.1469-0691.2007.01846.x","article-title":"Phenotypic detection of extended-spectrum \u03b2-lactamase production in Enterobacteriaceae: Review and bench guide","volume":"14","author":"Drieux","year":"2008","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s002640000176","article-title":"Urinary infection after orthopaedic procedures","volume":"25","author":"Munuera","year":"2001","journal-title":"Int. Orthop."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"7268985","DOI":"10.1155\/2016\/7268985","article-title":"Manning DW. Risk Factors for Postoperative Urinary Tract Infections in Patients Undergoing Total Joint Arthroplasty","volume":"2016","author":"Alvarez","year":"2016","journal-title":"Adv. Orthop."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.ajic.2014.11.014","article-title":"NHSN Annual Report: Data summary for 2013, Device-associated Module","volume":"43","author":"Dudeck","year":"2015","journal-title":"Am. J. Infect. Control"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Ko\u0142pa, M., Wa\u0142aszek, M., R\u00f3\u017ca\u0144ska, A., Wolak, Z., and W\u00f3jkowska-Mach, J. (2018). Hospital-Wide Surveillance of Healthcare-Associated Infections as a Source of Information about Specific Hospital Needs. A 5-Year Observation in a Multiprofile Provincial Hospital in the South of Poland. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15091956"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.1086\/503837","article-title":"Reduction of Urinary Tract Infection and Antibiotic Use after Surgery: A Controlled, Prospective, Before After Intervention Study","volume":"42","author":"Sax","year":"2006","journal-title":"Clin. Infect. Dis."},{"key":"ref_17","first-page":"38","article-title":"Urinary tract infections after early removal of urinary catheter in total joint arthroplasty","volume":"23","author":"Corigliano","year":"2019","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_18","first-page":"120","article-title":"Urinary retention after total hip and knee arthroplasty","volume":"76","author":"Balderi","year":"2010","journal-title":"Minerva Anestesiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1007\/s11999-008-0614-8","article-title":"Relationship between perioperative urinary tract infection and deep infection after joint arthroplasty","volume":"467","author":"Koulouvaris","year":"2008","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1111\/1469-0691.12527","article-title":"Postoperative urinary tract infection and surgical site infection in instrumented spinal surgery: Is there a link?","volume":"20","author":"Pigrau","year":"2014","journal-title":"Clin Microbiol. Infect."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1159\/000488251","article-title":"Healthcare-Associated Infections after Lower Urinary Tract Endoscopic Surgery: Analysis of Risk Factors, Associated Microorganisms and Patterns of Antibiotic Resistance","volume":"100","year":"2018","journal-title":"Urol. Int."},{"key":"ref_22","first-page":"53","article-title":"Catheter-associated urinary tract infections: Primary care guidelines","volume":"100","author":"Pellowe","year":"2004","journal-title":"Nurs. Times"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"S429","DOI":"10.1093\/cid\/cir108","article-title":"Candida urinary tract infections\u2014Epidemiology, pathogenesis, diagnosis, and treatment: Executive summary","volume":"52","author":"Fisher","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1086\/313583","article-title":"Prospective multicenter surveillance study of funguria in hospitalized patients","volume":"30","author":"Kauffman","year":"2000","journal-title":"Clin. Infect. Dis."},{"key":"ref_25","first-page":"273","article-title":"Intercontinental emergence of Escherichia coli clone O25:H4-ST131 producing CTX-M-15","volume":"61","author":"Blanco","year":"2008","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_26","unstructured":"European Centre for Disease Prevention and Control (2020). Antimicrobial Consumption in the EU\/EEA\u2014Annual Epidemiological Report 2019, ECDC. Available online: https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/Antimicrobial-consumption-in-the-EU-Annual-Epidemiological-Report-2019.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"258517","DOI":"10.1155\/2013\/258517","article-title":"Urinary Tract Infections due to Multidrug-Resistant Enterobacteriaceae: Prevalence and Risk Factors in a Chicago Emergency Department","volume":"2013","author":"Khawcharoenporn","year":"2013","journal-title":"Emerg. Med. Int."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1080\/1120009X.2017.1380395","article-title":"Multi-drug-resistant Gram-negative bacteria causing urinary tract infections: A review","volume":"29","author":"Mazzariol","year":"2017","journal-title":"J. Chemother."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/10\/1\/7\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:48:57Z","timestamp":1760179737000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/10\/1\/7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,23]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1]]}},"alternative-id":["antibiotics10010007"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics10010007","relation":{},"ISSN":["2079-6382"],"issn-type":[{"type":"electronic","value":"2079-6382"}],"subject":[],"published":{"date-parts":[[2020,12,23]]}}}