Postoperative infections in trauma surgery: Experience of the microbiology department at Ibn Tofail Hospital in Marrakech

Introduction: Postoperative infections in traumatology represent a serious complication in trauma surgery that limits the potential benefits of surgical interventions.  The objective of this study is to investigate the epidemiological profile and the level of resistance of the bacteria responsible for these infections at Ibn Tofail Hospital, to improve the management of these patients 
Materials and Methods: This is a retrospective descriptive study conducted over an 8-year period, from January 2015 to December 2023. Samples were collected from the trauma and orthopedics department and analyzed in the bacteriology laboratory at Ibn Tofail Hospital. 
Results: During the study period, 304 postoperative infections were diagnosed. All patients were adults, with a male-to-female ratio of 2.4. The majority of samples were deep-site cultures (67%). A total of 499 pathogens were isolated. The distribution by species was dominated by Staphylococcus aureus, which accounted for 15.4% of isolates, followed by Enterobacter aerogenes (12.6%), Proteus mirabilis (11.2%), and Acinetobacter baumannii (9.8%). Resistance rates showed that 87% of Enterobacteriaceae were resistant to the amoxicillin-clavulanic acid combination, 56% to fluoroquinolones, and 49% to third-generation cephalosporins. Resistance to imipenems founded in 81% of Acinetobacter baumannii strains, and the rate of methicillin-resistant S. aureus was 20%. Analysis of the correlation between the level of consumption of the antibiotics studied and antibiotic resistance rates showed that a 49% increase in the consumption of the amoxicillin-clavulanic acid combination and an 11% increase in ciprofloxacin consumption increased resistance to AMC by 87% but also resistance to C3G by 49%, resulting in an increase in multidrug resistance (36%).
Conclusion: In our setting, postoperative infections are typically deep-seated and caused by multidrug-resistant bacteria, which can lead to serious complications such as bacteremia and amputations. Management therefore requires a multidisciplinary approach, with particular emphasis on the laboratory’s role in monitoring treatment adherence and progress, thereby ensuring the appropriate use of antibiotic therapy.