Microbiological Profile and Antimicrobial Resistance Patterns Among Orthopedic Patients at a Tertiary Care Centre in Uttarakhand, India

BackgroundAntimicrobial resistance has complicated the management of bacterial infections among patients admitted to orthopedic wards by limiting effective treatment options and increasing the risk of treatment failure and prolonged hospitalization.This study aimed to describe the distribution of bacterial isolates and antimicrobial susceptibility patterns among patients admitted to an orthopedic ward and to identify clinical factors associated with multidrug-resistant (MDR) isolates. MethodsThis hospital-based cross-sectional study included 96 patients admitted to the orthopedic ward who had culture-positive clinical specimens and met the study eligibility criteria.Demographic and clinical characteristics, specimen types, bacterial isolates, previous antibiotic exposure, hospitalization history, implant status, and antimicrobial susceptibility profiles were recorded.MDR was defined as nonsusceptibility to at least one agent in three or more antimicrobial categories. ResultsThe mean age of the patients was 49.4 ± 18.8 years, and 58 (60.4%) were male.Urine was the most common specimen, comprising 50 (52.1%)samples.Escherichia coli was the predominant isolate, identified in 28 (29.2%)patients, followed by Staphylococcus aureus in 20 (20.8%).High rates of resistance were observed to cefazolin, cefepime, ciprofloxacin, and trimethoprim-sulfamethoxazole.MDR isolates were identified in 42 (43.8%)patients.MDR isolation was significantly associated with age >60 years, diabetes mellitus, orthopedic implant status, previous antibiotic exposure, previous hospitalization, and Gram-negative isolates.After adjustment for potential confounders, previous antibiotic exposure (adjusted OR=3.12, 95% CI: 1.20-8.16;p=0.020) and previous hospitalization (adjusted OR=2.73, 95% CI: 1.00-7.41;p=0.049) remained independently associated with MDR isolation.Patients with MDR isolates had a longer mean hospital stay than those without MDR isolates (14.1 ± 5.8 versus 8.9 ± 4.5 days; p<0.001); however, the crosssectional design precludes determination of the temporal direction of this association. ConclusionsAntimicrobial resistance and MDR isolates were common among patients admitted to the orthopedic ward.Previous antibiotic exposure and hospitalization were independently associated with MDR isolation, highlighting the importance of antimicrobial stewardship and appropriate microbiological evaluation in this population.