Abstract

Objective: With the increasing volume of trauma surgery, postoperative infections have garnered significant attention, as they not only affect patient outcomes but also raise healthcare costs and the risk of bacterial resistance. This study aims to analyze the microbial spectrum and antibiotic sensitivity of patients with postoperative infections in trauma surgery, providing a basis for clinical treatment and optimizing antibiotic usage strategies in this context. Methods: A retrospective analysis was conducted on patients with traumatic infections who were hospitalized in the departments of spine surgery, upper limb surgery, and lower limb surgery from January 2022 to December 2024. Bacterial culture-positive specimens were analyzed for bacterial species and antibiotic sensitivity. Results: A total of 804 traumatic infection specimens were submitted for testing, including 538 male patients (ages 2 - 95 years) and 266 female patients (ages 4 - 94 years). Among these, 267 cases showed positive culture results, with 172 males (ages 2 - 93 years) and 95 females (ages 4 - 94 years). A total of 153 strains of Gram-negative (G−) bacteria and 114 strains of Gram-positive (G+) bacteria were identified. Among G− bacteria, Escherichia coli was the most frequently isolated (40 strains), followed by Pseudomonas aeruginosa (28 strains) and Enterobacter cloacae (28 strains). Among G+ bacteria, Staphylococcus aureus was the most prevalent (75 strains), followed by Enterococcus faecalis (15 strains) and Streptococcus pyogenes (8 strains). Antibiotic sensitivity testing revealed that the resistance rate of Staphylococcus aureus to penicillin was as high as 93.33%, while the resistance rate of Escherichia coli to trimethoprim-sulfamethoxazole was 57.5%. Conclusion: The main pathogens responsible for postoperative infections in traumatology are Escherichia coli and Staphylococcus aureus, with significant antibiotic resistance. In clinical treatment, antibiotics should be selected rationally based on bacterial spectrum and resistance patterns to improve treatment efficacy.

Keywords

Traumatic Infection, Microbial Spectrum, Antibiotic Sensitivity, Escherichia Coli, Staphylococcus Aureus

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1. Introduction

Traumatic infections are one of the common complications following surgical procedures, profoundly impacting patient prognosis. They not only prolong hospital stays and increase medical costs but can also exacerbate patient conditions and even pose life-threatening risks, presenting significant challenges for clinical treatment [1]. With the widespread use of antibiotics, bacterial resistance to these medications has gradually increased, a phenomenon particularly pronounced among patients with traumatic infections [2]. Therefore, understanding the microbial spectrum and antibiotic sensitivity of infections following traumatic surgical procedures is crucial for optimizing antibiotic usage strategies and reducing the emergence of resistant strains [3] [4].

In recent years, there has been a notable shift in the spectrum of pathogens responsible for traumatic infections, with variations observed across different regions and hospitals. For instance, some studies have found that the distribution of Gram-positive (G+) and Gram-negative (G−) bacteria and their resistance profiles may be influenced by multiple factors, including hospital type, geographic region, and patient demographics [5] [6]. Hence, a systematic investigation of the pathogens causing traumatic infections in specific regions and hospitals can provide more precise evidence for clinical antibiotic use.

This study aims to analyze bacterial detection and antibiotic sensitivity in patients with traumatic infections hospitalized in the spinal, upper limb, and lower limb departments of Wuzhou Traditional Chinese Medicine Hospital from January 2022 to December 2024. The selected study subjects include cases of infections following spinal, upper limb, and lower limb surgeries, representing common types of traumatic infections encountered in current clinical practice. To ensure the reliability and accuracy of the results, standardized bacterial culture and antibiotic susceptibility testing methods will be employed. Furthermore, statistical analyses will be used to evaluate antibiotic sensitivity and resistance rates, providing data support for the rational use of antibiotics and contributing to improved clinical outcomes for patients [7] [8]. Through this research, we hope to reveal the microbial spectrum of traumatic infections and their antibiotic sensitivity characteristics, offering important references for optimizing clinical treatment strategies and thereby reducing the medical burden and patient risks associated with traumatic infections.

2. Materials and Methods

2.1. Study Subjects

This study utilized a retrospective analysis method, including patients with traumatic infections who were hospitalized in the spinal, upper limb, and lower limb departments of Wuzhou Traditional Chinese Medicine Hospital between January 2022 and December 2024. A total of 267 patients’ clinical data were included in the analysis to assess the clinical and microbiological characteristics of different types of traumatic infections. The study was approved by the Ethics Committee of Wuzhou Traditional Chinese Medicine Hospital, and all patients’ personal information was kept strictly confidential, adhering to the principles outlined in the Declaration of Helsinki to ensure ethical compliance [9].

2.2. Inclusion Criteria

1) Patients were hospitalized and underwent surgical procedures in the spinal, upper limb, or lower limb departments.

2) Symptoms of infection appeared post-surgery and were confirmed as bacterial infections through bacterial culture.

2.3. Exclusion Criteria

1) Patients who had received antibiotic treatment prior to hospitalization, which could affect culture results.

2) Cases are unable to provide complete clinical and laboratory data, as missing information could impact on the accuracy of the data and the reliability of the research findings.

2.4. Methods

2.4.1. Bacterial Culture

All samples from infected patients (see Figure 1), including wound secretions, blood, and other relevant specimens, were subjected to bacterial culture (see Figure 2). Inoculation was performed using blood agar, MacConkey agar, and fungal identification plates produced by Antu Biotechnology Co., Ltd., employing the quadrant streaking method. All media and conditions adhered to standard operating protocols (see Figure 3). During the cultivation process, strict aseptic techniques were followed to ensure the accuracy and reliability of the results [10].

Single colonies were picked for identification and antimicrobial susceptibility testing, using the Mérieux identification and susceptibility testing system, which included Mérieux identification cards and susceptibility test cards. First, it was ensured that the power supply for the instrument met the requirements, and the AC power switch was turned on to initialize the device, which included self-checks and the temperature rise of the incubation turntable to reach the temperature required for testing card cultivation.

Next, the testing cards and saline bottles were taken out of the refrigerator and allowed to equilibrate to room temperature. Disposable plastic test tubes were placed on the card holder, with 3 mL of 0.45% NaCl solution added to each tube. A turbidity meter was used to calibrate the tubes, ensuring the readings were within the specified range. Then, bacterial suspensions were prepared as needed, and the concentration of the bacterial suspension was measured with a turbidity meter to ensure the appropriate concentration. The testing cards were placed on the card holder, with the susceptibility test card behind the identification card. After placing the card holder into the instrument, the barcodes of the holder and cards were scanned automatically.

Figure 1. Postoperative wound infection status of patients.

Figure 2. Specimens from patients with infections after trauma surgery.

Figure 3. Bacterial culture results of patient specimens.

Subsequently, the card holder was placed in the filling chamber of the instrument, where it was automatically filled, sealed, and loaded. The identification card and susceptibility test card were linked to the instrument’s operating system, and sample information was entered. Identification and susceptibility results were automatically generated by the instrument, which may include supplemental tests to ensure the accuracy of the results. After processing, the results were transmitted to the LIS database for reporting. Additionally, regular cleaning of various components of the instrument was required, including the waste card slot, filling chamber, optical reader, incubation turntable, and card holder.

2.4.2. Antimicrobial Susceptibility Testing

Antimicrobial susceptibility testing was conducted using the VITEK-2 compact automated microbiological identification and susceptibility testing system from bioMérieux, along with the corresponding identification and susceptibility cards (see Figure 4). The tests aimed to assess the sensitivity of various bacterial strains to commonly used antibiotics. Interpretation of susceptibility results followed the standards set by the Clinical and Laboratory Standards Institute (CLSI), and the resistance rates of each bacterial strain were recorded. This process provides important evidence for clinicians to develop appropriate antibiotic treatment regimens [11].

Figure 4. Results of bacterial antimicrobial susceptibility testing.

2.5. Data Analysis

Data analysis was performed using SPSS version 26.0 statistical software. For qualitative data, chi-square tests were employed; for quantitative data, independent samples t-tests were used. Statistical significance was set at P < 0.05 to determine the reliability and clinical relevance of the results. Through these analyses, we could gain insights into the relationships between various factors and traumatic infections, providing references for future clinical management [12].

3. Results

3.1. Bacterial Detection

From January 2022 to December 2024, a total of 804 specimens were submitted for testing, including 538 male patients aged 2 to 95 years and 266 female patients aged 4 to 94 years. Bacterial cultures yielded positive results in 267 cases, resulting in a positive rate of 33.2%. Among the positive cases, there were 172 male patients (aged 2 to 93 years) and 95 female patients (aged 4 to 94 years). This data indicates that male patients constitute a relatively higher proportion of bacterial infections.

In terms of bacterial species distribution, among the 267 identified bacterial strains, 153 were Gram-negative (G−) bacteria, accounting for 57.3% of the total detected; while 114 were Gram-positive (G+) bacteria, representing 42.7%. This result highlights the significance of different types of bacteria in wound infections. Notably, Staphylococcus aureus and Escherichia coli were the most frequently detected bacteria, with 75 and 40 strains respectively, underscoring their clinical relevance in wound infections. Additionally, Pseudomonas aeruginosa and Enterobacter cloacae were also relatively common, with both having 28 strains detected, suggesting their potential pathogenic role in this patient population.

Among the positive cases, male patients (172 cases) accounted for 64.4% of the total, while female patients (95 cases) made up 35.6%. This data indicates that males have a higher prevalence of bacterial infections, possibly related to increased exposure to risk factors in daily life, such as higher exposure to contaminated environments and workplace hazards. Moreover, the age distribution of male patients is broader, ranging from 2 to 93 years, while female patients ranged from 4 to 94 years, suggesting a degree of similarity in the age demographics of infection occurrence between genders.

The clinical manifestations among the 267 positive cases varied, with common symptoms including fever, local redness, and pain. Most patients with positive bacterial cultures showed symptom improvement after receiving antibiotic treatment; however, a subset of patients required further medical intervention due to the severity of their infections, illustrating the complexity of bacterial infections and the challenges associated with treatment. Detailed distribution of microbial species is presented in Table 1.

Table 1. Distribution of microbial spectrum in 267 patients with wound infections.

Note: The names and numbers have been translated and formatted in a typical table layout used in English-language scientific papers. Adjust the bacterial species names if there are specific conventions or common names in English that should be used.

3.2. Antibiotic Susceptibility Analysis

Through an in-depth analysis of the data, we found significant differences in antibiotic resistance between Gram-positive (G+) and Gram-negative (G−) bacteria, with statistical significance (P < 0.05). To further understand the resistance patterns, we conducted a detailed susceptibility analysis on the five most prevalent bacterial species. The results indicated that Staphylococcus aureus and Escherichia coli exhibited high resistance rates. This finding suggests that a more cautious approach should be adopted in clinical treatment to address the increasingly serious issue of antibiotic resistance.

By analyzing the antibiotic susceptibility of the major pathogens, we can clearly observe the differences in resistance rates, particularly highlighted in Staphylococcus aureus and Escherichia coli. These differences will have a direct impact on the selection of clinical treatment regimens, especially during the initial phase of antibiotic therapy. The high resistance of Staphylococcus aureus may be related to its biofilm-forming ability and its adaptability in hospital environments, while the high resistance rate of Escherichia coli may be associated with the misuse and inappropriate use of antibiotics. The results of the antibiotic susceptibility tests for the top five prevalent bacteria are detailed in Table 2.

Table 2. Distribution of microbial spectrum in 267 patients with wound infections.

4. Discussion

The results of this study reveal that the main pathogens responsible for post-traumatic surgical infections are Escherichia coli and Staphylococcus aureus. This finding is consistent with numerous related studies both domestically and internationally [13]-[15]. With the widespread use of antibiotics, the emergence of resistant strains has posed unprecedented challenges for clinical treatment. Antibiotic resistance not only prolongs the length of hospital stays but also increases medical costs and mortality rates, thus necessitating urgent attention [16] [17]. In our study, the prevalence and resistance of Staphylococcus aureus raised significant concerns. Data indicated that the resistance rate of Staphylococcus aureus to penicillin reached as high as 93.33%, a result that aligns with other studies, demonstrating the widespread resistance of this pathogen in clinical settings [18] [19]. This phenomenon may be closely related to the extensive use and misuse of penicillin [20]. As a common skin commensal, the resistance of Staphylococcus aureus makes it a deadly threat in postoperative infections [21]. On the other hand, the resistance rate of Escherichia coli to co-trimoxazole was 57.5%, a result that should also not be overlooked [22]. Escherichia coli is a common inhabitant of the intestinal flora, typically non-pathogenic under normal circumstances, but its pathogenicity significantly increases in immunocompromised patients or following surgical trauma [23]. The occurrence of resistance may be associated with improper use of antibiotics, contamination in healthcare environments, and various underlying patient conditions [24] [25].

In current medical practice, the selection of antibiotics is crucial. Our study suggests that special attention should be paid to resistance patterns when selecting antibiotics in clinical settings, to avoid the indiscriminate use of broad-spectrum antibiotics. Such indiscriminate use not only fails to effectively control infections but also exacerbates the development of resistance [26] [27]. Therefore, the following principles should be adhered to in antibiotic use: 1) Individualized Treatment: Tailor treatment based on the patient’s specific conditions, pathogen culture results, and antibiotic sensitivity [28]. Each patient’s clinical status, underlying diseases, allergy history, and resistance patterns may influence the efficacy of antibiotics [29]. 2) Rapid Pathogen Detection: Where possible, conducting rapid pathogen detection and resistance analysis is essential for guiding rational antibiotic use [30]. Quick detection can promptly identify the infectious pathogen and its resistance, providing timely and effective treatment guidance for clinicians [31]. 3) Regular Monitoring of Hospital Infections: Monitoring nosocomial infections is a critical measure for preventing and controlling resistance [32]. By establishing data monitoring systems to promptly collect and analyze changes in pathogens and their resistance in hospital infections, healthcare institutions can timely adjust their antibiotic use strategies [33].

The emergence of antibiotic-resistant bacteria is a complex process involving multiple factors. First, the abuse and inappropriate use of antibiotics are primary reasons for the increase in resistance. Clinically, some physicians may prematurely use potent broad-spectrum antibiotics due to patients’ desires for rapid therapeutic effects, even in the absence of clear evidence of infection, inadvertently creating opportunities for the selection of resistant strains [34]. Secondly, patient-related factors, such as age, underlying diseases, and immune status, can also influence the efficacy of antibiotics and the development of resistance [35]. Additionally, the lack of environmental hygiene and infection control measures significantly contributes to the increase in resistance; inadequate infection control in hospitals and cross-infections between patients can lead to the spread of resistant strains [36].

The emergence of resistant bacteria poses numerous challenges for clinical treatment. First, there is a limitation in treatment options. As resistant strains increase, physicians face greater difficulties in selecting antibiotics; conventional antibiotic therapies may lose their effectiveness, leading to inadequate infection control and even more severe complications [37]. Moreover, the rise in resistance leads to increased medical costs. With the widespread presence of resistant bacteria, patients often require longer hospital stays and more expensive alternative medications, further burdening the healthcare system [38]. Statistics indicate that the treatment costs for patients with resistant infections are often several times higher than those for patients with sensitive infections, imposing significant economic pressure on families and society [39]. Furthermore, the spread of resistant bacteria is not confined to hospitals; they can also enter the broader community through community transmission [40]. This mode of transmission poses greater challenges for public health, especially in regions where antibiotics are misused [41]. Thus, implementing effective preventive measures is crucial, including strengthening antibiotic management, raising public awareness of antibiotic resistance, and enhancing infection control measures at the community level [42] [43].

To address this serious challenge, several initiatives and action plans have been proposed globally. For example, the World Health Organization (WHO) has released a Global Action Plan on Antimicrobial Resistance aimed at raising awareness of the issue and promoting coordinated efforts among countries to combat antibiotic resistance [44]. At the same time, countries are actively exploring the development of new antibiotics and alternative therapies, such as phage therapy and immunotherapy, in hopes of effectively addressing the threats posed by resistance in the future [45] [46].

In our study, we also observed a significant positive correlation between patients’ length of hospital stay and the antibiotic resistance of the infectious pathogens. This indicates that early identification of infectious pathogens and their resistance patterns, along with timely adjustments to treatment protocols, is crucial for reducing hospital stay durations and lowering the incidence of complications [47]. Our findings highlight the importance of establishing a rapid and effective pathogen detection system in clinical practice, which not only aids in optimizing antibiotic use but also enhances overall treatment outcomes for patients [48].

In summary, the issue of pathogens and their antibiotic resistance following traumatic orthopedic surgery is an urgent public health challenge that needs to be addressed. By strengthening antibiotic management, raising awareness among clinicians regarding antibiotic use, and enhancing patient health education, we aim to reduce the occurrence and transmission of resistant bacteria in the future. This, in turn, could improve clinical outcomes, lower healthcare costs, and ensure patient safety.

5. Conclusion

This study analyzed the microbial spectrum and antibiotic susceptibility of patients with infections following traumatic orthopedic surgery, revealing that Escherichia coli and Staphylococcus aureus were the predominant pathogens, both exhibiting high resistance rates. These findings underscore the critical importance of rational antibiotic use in controlling infections and improving treatment outcomes. In clinical practice, it is recommended to select antibiotics based on bacterial culture and sensitivity test results to minimize unnecessary broad-spectrum antibiotic use. Furthermore, hospitals should establish a comprehensive antibiotic usage monitoring system, regularly evaluate the spectrum of pathogens and their resistance patterns, and timely adjust clinical treatment protocols to optimize antibiotic usage strategies, reduce the incidence of resistant bacteria, and enhance patient treatment outcomes and safety.

6. Limitations of the Study

The sample size of this study may not be sufficient to represent a broader population, which could affect the generalizability and applicability of the results. The timeframe of the study may have limited data collection and analysis, potentially leading to missed dynamic changes or trends. Relying on specific data sources may introduce selection bias, impacting the objectivity of the study findings. The methodologies employed may not fully capture the complexity of the subjects under investigation; for instance, quantitative research may inadequately reflect participants’ subjective experiences. Additionally, there may be uncontrolled external variables during the study process that could influence the results, complicating the interpretation of the findings.

Acknowledgments

We would like to express our gratitude to all the medical staff from the Department of Spine Surgery, Upper Limb Surgery, and Lower Limb Surgery at Wuzhou Traditional Chinese Medicine Hospital for their support and cooperation, which provided valuable case data for this study. We would also like to thank the laboratory technicians for their hard work, ensuring the accuracy of bacterial cultures and sensitivity testing.

NOTES

*First author.

#Co-corresponding author.

Conflicts of Interest

The authors declare that there are no potential personal conflicts of interest in this study. All research processes and results are based on scientific evidence and clinical data, and have not been influenced by any commercial interests or external organizations. The authors commit to maintaining integrity and transparency throughout the research, ensuring the objectivity and reliability of the findings. If any potential conflicts of interest arise related to this study, the authors will disclose them promptly in subsequent academic communications.

References