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.

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.

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.

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.

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.

*First author.

#Co-corresponding author.