Predominance of Gram-Negative Bacteria and Their Antibiotic Resistance Profiles in Orthopedic Implant Infections at a Tertiary Hospital in Kenya

Predominance of Gram-Negative Bacteria and Their Antibiotic Resistance Profiles in Orthopedic Implant Infections at a Tertiary Hospital in Kenya | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Predominance of Gram-Negative Bacteria and Their Antibiotic Resistance Profiles in Orthopedic Implant Infections at a Tertiary Hospital in Kenya Okemwa Sophia Moraa, Lilian Ogonda, James Kombok, Ongwae H. Zachariah This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7436707/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Implant-related infections are a major complication of orthopedic implant surgeries and represent a significant public health concern, as they contribute to prolonged morbidity, increased antibiotic use, and high treatment costs. This study aimed to identify the bacterial species involved in these infections, analyze their distribution across infection phases and determine their antimicrobial susceptibility profiles among patients receiving surgical care at Kakamega County Teaching and Referral Hospital, Kenya. Methods This was a hospital-based, descriptive cross-sectional study conducted between August 2024 and April 2025. From a target population of approximately 600 patients orthopedic implant patients, 191 were systematically selected after obtaining informed consent. Swab samples were collected and cultured on Sheep Blood Agar (SBA), Chocolate agar and MacConkey agar supplemented with Crystal violet. Purity plating was performed to isolate pure colonies. Bacterial identification and antimicrobial susceptibility testing (AST) were conducted using the VITEK 2 system. The interpretation of AST results was done according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Descriptive statistics were used to determine the frequency of bacterial species and their antibiotic susceptibility patterns. Results The most prevalent Gram-negative bacterial species isolated were Klebsiella pneumoniae (29.2%), Escherichia coli (17.9%), Pseudomonas aeruginosa (16.9%), and Citrobacter freundii (10.3%). Other Gram-negative bacteria, including Proteus mirabilis (4.1%), Providencia stuartii, Raoultella ornithinolytica and Klebsiella oxytoca, were each detected in less than 2.2% of cases. Staphylococcus aureus (14.9%) and Staphylococcus epidermidis (2.1%) were the only Gram-positive species isolated . No bacterial growth was observed in 1.0% of the samples. The distribution of infections by phase was 47.7% in the early phase, 50.7% in the delayed phase, and 1.6% in the late phase. High resistance rates were observed to ampicillin, penicillin, vancomycin, and the cephalosporins cefazolin, cefixime, ceftriaxone, and Ceftazidime. In contrast, amikacin and piperacillin-tazobactam showed the highest sensitivity across multiple isolates. Conclusion These findings demonstrate a marked predominance of Gram-negative bacteria as the primary causative agents of orthopedic implant infections at the study site, suggesting a potential shift from Staphylococcus aureus, which is indicated in most studies as the leading pathogen. The observed resistance pattern highlights the need for routine, individualized antimicrobial susceptibility testing to guide effective, targeted antibiotic therapy in postoperative orthopedic implant infections. Infectious Diseases Orthopedic implant infections Gram-negative bacteria Antibiotic susceptibility Antimicrobial resistance Figures Figure 1 Figure 2 Background Infections involving orthopedic implants are a major complication following surgical fixation or joint replacement procedures[ 1 ] .They contribute significantly to repeated surgical interventions, extended antibiotic therapy, prolonged morbidity, and substantial economic burden on both patients and healthcare systems[ 2 ]. These infections are difficult to treat due to formation of bacterial biofilm on implant surfaces, which confer resistance to host immune responses and reduce the efficacy of antibiotics [ 1 ].The mortality rate due to Prosthetic Joint Infections (PJI) ranges from 0.4–7% in geriatric patients aged 65 to 80 years old [ 3 ]. Fracture-related infections (FRI) occur in approximately 1–2% of closed fractures requiring internal fixation and in up to 30% of open fractures, such as tibial fractures[ 4 ]. In Kenya, the overall infection rate following orthopedic implantation procedures is estimated at approximately 13.8%, although this figure is likely underestimated due to a lack of standardized surveillance protocols for detecting implant-related infections[ 5 ]. At Kakamega County Teaching and Referral Hospital (KCTRH), hospital records indicated that approximately 18% of orthopedic patients returned with suspected implant infections. However, most of these cases were managed empirically without microbiological confirmation, primarily due to financial constraints that limited access to culture and sensitivity testing (Outpatient Quarterly Morbidity Report, 2023). Globally, most studies on orthopedic implant infections have focused on Gram-positive bacteria, particularly Staphylococcus aureus , which is widely recognized as the predominant etiological agent [ 6 ]. However, emerging evidence indicates an increasing involvement of Gram-negative bacteria, such as Klebsiella pneumoniae , Escherichia coli and Pseudomonas aeruginosa , as common etiological agents in these infections, especially in low- and middle-income countries (LMICs) [ 7 ], [ 8 ]. For instance, Sarkar et al. (2024)[ 8 ] reported that 68% of isolates from orthopedic implant infections in a tertiary care hospital in India were Gram-negative, with most exhibiting high biofilm formation and multidrug resistance [ 2 ]. Similarly, a study from Brazil found that 57.3% of implant related infections were caused by Gram –negative bacteria, with Acinetobacter baumannii accounting for 14.9% of cases[ 9 ]. These Gram-negative bacteria frequently exhibit resistance to multiple antibiotic classes, including cephalosporins, aminoglycosides, and fluoroquinolones, and in some cases, carbapenems, posing significant therapeutic challenges [ 10 ]. Despite their clinical importance, region-specific data on the diversity of bacterial species and their antibiotic resistance profiles in orthopedic implant infections remain limited, particularly in low- and middle-income countries such as Kenya. The inappropriate and widespread use of antibiotics has driven the emergence of resistant pathogens, leaving few or sometimes no effective agents to treat infections they cause [ 11 ]. Orthopedic implant-associated infections are typically classified based on the time of onset into early ( 10 weeks)[ 12 ]. However, there is ambiguity regarding whether this timing refers to time interval from the initial injury, the implant fixation, or the onset of clinical symptoms, and which, if any, is clinically relevant. This classification is widely adopted though, as it is likely to influence treatment decisions [ 4 ]. Recent analysis of the bacteriological etiology in fracture-related infections and prosthetic joint infections suggest that a similar bacterial profile may be present across all three phases[ 13 ]. Therefore, this study aimed to characterize the bacterial species responsible for orthopedic implant-related infections at a tertiary hospital in western Kenya, analyze the bacterial profile at the various phases of infection and to determine their antimicrobial resistance profiles. The findings are intended to inform evidence-based clinical management and support the development of more effective infection prevention and treatment strategies in similar resource-limited healthcare settings. Methods Study design and study area A cross-sectional study was conducted at Kakamega County teaching and referral hospital between August 2024 and March 2025. This Level 5 hospital serves as the primary referral center for Kakamega County and neighboring regions. Motorcycle accidents are a major cause of trauma-related injuries in this area, contributing significantly to the burden of orthopedic cases (Outpatient Quarterly Morbidity Report, 2023). Study population, sample size and sampling technique. The study population consisted of patients presenting with implant-related surgical site infections following orthopedic surgery at Kakamega County Teaching and Referral Hospital. A purposive sampling technique was employed. The sample size of 191 participants was calculated using the formula described by Fisher et al . (1999) and adjusted using the finite population correction formula. Data was collected at the orthopedic outpatient clinic and inpatient wards, as well as intraoperatively during surgical interventions from consecutive patients with implant-related surgical site infections. Data collection procedures Data was collected using a structured questionnaire to obtain baseline demographic information. Pus swabs were collected after cleaning the infection site with normal saline to remove necrotic tissue, dry exudates and dressing residues. The samples were immediately transferred to the hospital’s microbiology laboratory using Amies transport medium. Direct smears were prepared for Gram staining. Standard culturing was performed on blood agar (incubated anaerobically at 37°C for 24 hours), Chocolate agar (incubated anaerobically at 37°C for 24 hours) and MacConkey agar with crystal violet (incubated aerobically at 37°C for 24 hours). Purity plating was done on the cultured bacteria to isolate pure cultures. Bacteria identification and antimicrobial susceptibility testing were carried using the VITEK 2 system. Stock cultures of Staphylococcus aureus ATCC 25923 and Escherichia coli ATCC 25922 were used as control strains. Data management and analysis The data was organized and managed using Epi Info version 3.4.3. Statistical analysis was performed using SPSS version 25. Descriptive statistics were used to summarize data on bacterial isolates, and antimicrobial susceptibility patterns. Results and Discussion Demographic characteristics of participants As shown in table 1 below, the distribution of age ranges from under 18 years to above 73 years. The gender distribution of the participants indicates that 126 (66.0%) were male and 65 (34.0%) were female. The data reveals a higher prevalence of male participants in the study. Most of the participants (65.4%) reported no comorbidities. Among those with comorbidities, diabetes and hypertension were the most common, each accounting for 16.2% and 16.7% of the participants. Other comorbid conditions, such as alcoholism, diabetes combined with hypertension, and hypertension combined with prostatectomy, were reported at much lower frequencies (0.5% each). This distribution highlights that while some participants have specific health conditions, the majority are free of comorbidities. The types of injuries among the participants varied significantly, with fractures being the most prevalent. Femur fractures were the most common, accounting for 37.7% of cases, followed closely by tibia fractures (34.0%). Other notable injuries included ulna fractures (15.7%) and pelvic fractures (10.5%). Less frequent injuries such as fibular fractures (1.6%) and humerus fractures (0.5%) were observed in a small proportion of cases. The data indicate a predominance of bone fractures, highlighting the severity of injuries experienced by the participants. The use of different types of implants among the participants varied, with external fixation (exofix) being the most common, used in 37.2% of cases. Pins and wires followed closely, accounting for 35.1% of the implant types. Plates were used in 25.7% of cases, indicating a significant reliance on these devices for injury management. Implant removal was relatively rare, occurring in only 2.1% of cases. Table 1: Demographic and Clinical Characteristics of Participants Variables Frequency (n) Percentage (%) Age (years) ≤ 18 10 5.2% 19-29 40 20.9% 30-40 60 31.4% 41-51 50 26.2% 52-62 25 13.1% ≥ 73 6 3.1% Sex Male 126 66.0% Female 65 34.0% Comorbidities Diabetes and Hypertension 1 0.5% Hypertension and Prostatectomy 1 0.5% Alcoholism 1 0.5% Diabetes 31 16.2% Hypertension 32 16.7% None 125 65.4% Injury Type Humerus fracture 1 0.5% Fibular fracture 3 1.6% Pelvic fracture 20 10.5% Ulna fracture 30 15.7% Tibia fracture 65 34.0% Femur fracture 72 37.8% Implants Implant removal 4 2.1% Plate 49 25.7% Pins and wires 67 35.1% Exofix 71 37.2% Common B acterial S pecies R esponsible for O rthopedic I mplant I nfection s As shown in table 2, a variety of Gram-negative bacteria were isolated from participants with implant-related infections. Klebsiella pneumoniae was the most frequently isolated species, accounting for 29.2% of the isolates. Other common bacteria included Escherichia coli (17.9%), and Pseudomonas aeruginosa (16.9%). Citrobacter freundii and Proteus mirabilis were also notable, accounting for 10.3% and 4.1% of isolates, respectively. Less frequently isolated species included Providencia stuartii, Raoultella ornithinolytica, and Klebsiella oxytoca, each comprising less than 2.0% of the isolates. Staphylococcus aureus (14.9%) and Staphylococcus epidermidis (2.1%) were the only Gram-positive species isolated. Table 2: Bacteria Isolated from Implant-Related Infections BACTERIA ISOLATED Frequency Percentage (%) Klebsiella pneumoniae 57 29.2 E.Coli 35 17.9 P. aeruginosa 33 16.9 Staphylococcus aureus 29 14.9 Citrobacter freundii 20 10.3 Proteus mirabillis 8 4.1 S. epidermidis 4 2.1 Providencia stuartii 3 1.5 Raoultella ornithinolytica 2 1.0 Klebsiella oxyotoca 2 1.0 No bacteria growth 2 1.0 Total 195 100 Bacterial profile at the V arious P hases of I mplant I nfection Table 3 presents the distribution of bacterial species across the different phases of implant-related infections, highlighting variations in pathogen prevalence at each stage. Klebsiella pneumoniae was the most frequently isolated pathogen, predominantly found in the early phase (38.6% of its isolates) and the delayed phase (61.4%). Escherichia coli was also prevalent, with 54.3% of the isolates identified in the early phase, 40.0% in the delayed phase, and 5.7% in the late phase. Pseudomonas aeruginosa was isolated in both early (39.4% of the cases) and delayed (60.6% of the cases) phases. Citrobacter freundii was primarily present in the early phase (75.0%) and to a lesser extent in the delayed phase (25.0%). Other less frequently isolated species included Proteus mirabilis (62.5% early, 37.5% delayed), Providencia stuarti (66.7% delayed, 33.3% late), Klebsiella oxytoca (100% early), and Raoultella ornithinolytica (100% delayed). The late phase showed minimal bacterial presence, with only two isolates: one Escherichia coli and one Providencia stuartii ). Table 3: Distribution of Bacteria Isolated Across Phases of Implant-Related Infection PHASE OF INFECTION BACTERIA ISOLATED Early Delayed Late Total Klebsiella pneumoniae 22 (38.6%) 35 (61.4%) 0 (0%) 57 Escherichia coli 19 (54.3%) 14 (40%) 2 (5.7%) 35 Pseudomonas aeruginosa 13 (39.4%) 20 (60.6%) 0 (0%) 33 Staphylococcus aureus 12 (41.4%) 17 (58.6%) 0 (0%) 29 Citrobacter freundii 15 (75%) 5 (25%) 0(0%) 20 Proteus mirabilis 5 (62.5%) 3 (37.5%) 0 (0%) 8 Staphylococcus epidermidis 4 (100%) 0 (0%) 0 (0%) 4 Providencia stuartii 0 (0%) 2 (66.7%) 1 (33.3%) 3 Klebsiella oxytoca 2 (100%) 0 (0%) 0 (0%) 2 Raoultella ornithinolytica 0 (0%) 2 (100%) 0 (0%) 2 Total 92 (47.7%) 98 (50.7%) 3 (1.6%) 193 Antibiotic Response Patterns Associated with Orthopedic Implant Infections Table 4 summarizes the antibiotic susceptibility profiles of all the bacterial isolates obtained from orthopedic implant infections. The responses are categorized as Resistant (R), Sensitive (S), and Intermediate (I). Susceptibility testing revealed widespread multidrug resistance to commonly used antibiotics. All isolates (100%) were resistant to penicillin, while high resistance rates were also observed for ceftriaxone (97.9%), cefazolin (96%), cefotaxime (88.2%), ampicillin (85%), and vancomycin (84.6%). These findings highlight the limited efficacy of vancomycin, as well as b-lactam antibiotics, including first- and second-generation cephalosporins in the treatment of implant-related infections in this setting. In contrast, amikacin demonstrated the highest sensitivity rate, with 98% of isolates susceptible, followed by meropenem (84.1%), and piperacillin-tazobactam (69.2%), indicating their potential effectiveness in treating these infections. Resistance to ciprofloxacin (49.7%), clindamycin (48.2%) and gentamicin (28.7%) was considerable, though lower than that observed with b-lactam antibiotics. Table 4: Antibiotic Response Patterns versus their response to all bacterial isolates Response/ percentage Antibiotic Resistant % Sensitive % Intermediate % Penicillin 193 100 0 0 0 0 Ceftriaxone 189 97.9 0 0 4 2.1 Cefazolin 186 96 4 2 3 2 Amoxyclav 181 93.7 4 2.1 8 4.2 Cefotaxime 170 88.2 23 11.8 0 0 Ceftazidime 166 85.1 27 14.9 0 0 Ampicillin 166 85 27 15 0 0 Vancomycin 163 84.6 30 15.4 0 0 Cefixime 119 61 66 33.9 8 5.1 Ciprofloxacin 97 49.7 88 46.1 8 4.1 Clindamycin 92 48.2 99 50.8 2 1 Erythromycin 92 48.2 99 50.8 2 1 Cefoxitin 75 38.5 118 61.5 0 0 Piperacillin-tazo 60 30.8 133 69.2 0 0 Gentamycin 56 28.7 112 58.4 25 12.8 Meropenem 19 10.7 164 84.1 10 5.1 Amikacin 0 0 189 98 4 2 Antibiogram Analysis Graph 1 illustrates the antibiotic resistance patterns observed among the bacterial species isolated from orthopedic implant infections. High resistance rates were noted for ampicillin, penicillin, vancomycin, and cephalosporins, including Cefazolin, Cefixime, Ceftriaxone, and Ceftazidime. Klebsiella pneumoniae demonstrated broad resistance across multiple antibiotic classes. In contrast, resistance rate was low for piperacillin-tazobactam, Amikacin, and meropenem, indicating their potential efficacy in this clinical setting. Graph 2 presents the antibiotic sensitivity patterns of the same bacterial species. Amikacin, meropenem, and piperacillin-tazobactam show the highest sensitivity across multiple isolates. In contrast, ampicillin, penicillin, and vancomycin demonstrated low sensitivity rates. Both Klebsiella pneumoniae and Klebsiella oxytoca exhibited resistance to most cephalosporins but retained sensitivity to aminoglycosides, particularly amikacin. These patterns highlight the importance of local antibiogram data in guiding empirical antibiotic therapy. Discussion Demographics Participants age captured a diverse age distribution. However, participants aged between 30 to 40 years old were most affected at 31.4%. 66% of the participants were male while 34% were female suggesting higher prevalence of men getting orthopedic implant infections. These phenomena are attributed to increased exposure to risk factors according to Lumbe et al. (2024) [ 14 ]. 65% of the participants were free of any comorbidities while those with diabetes were 16.2%, hypertension 16.7%, lower frequencies at 0.5% each was seen for hypertension combined with diabetes, with prostatectomy and in alcoholism. This distribution highlights that while some participants were free of any comorbidities many have specific health conditions hence a necessity to have tailored interventions as well as prevention measures. All participants in the study had bone fractures as the cause of injury and none had implants due to joint replacements. Femur fractures at 37.7% of cases, tibia fractures 34.0%, ulna fractures 15.7%, pelvic fractures 10.5%, fibular fractures1.6% and humerus fractures 0.5% aligning with data from similar studies Lumbe et al. (2024)[ 14 ]. The data suggests a diverse use of implants, with a notable preference for external fixation and pins and wires in treating injuries. Exofix was used in 37.2% of cases, Pins and wires in 35.1%, Plates in 25.7% of cases while 2.1% of the cases were implant removals as interventions in cases of implant failure due to infections. Common Bacterial Species Responsible for Orthopedic Implant Infections This study revealed the presence of diverse Gram-negative bacterial species among participants with orthopedic implant infections. Klebsiella pneumoniae was the most frequently isolated pathogen, although other bacterial species also played a role. This Gram-negative enterobacterium is increasingly associated with severe infections and high mortality rates [ 15 ] .The distribution of these organisms is influenced by a variety of epidemiological factors including host-related conditions and perioperative practices [ 16 ].Other contributing factors may include delayed fracture healing, post-surgical trauma, sepsis and contamination at the surgical sites[ 17 ]. Our findings are consistent with studies showing an upward trend in Gram-negative bacterial involvement in orthopedic implant-related infections. For instance, a study in Russia reported an increase in Gram-negatives isolates from 25–33% [ 18 ]. Similar trends were observed in Sweden and Lithuania, where Gram-negative pathogens dominated implant-related infections [ 19 ]Studies in West Africa[ 20 ] and India[ 8 ] also reported a higher prevalence of Gram-negative bacteria compared to Gram-positives. In our study, Pseudomonas aeruginosa was also isolated in 16.9% of cases, aligning with previously reported prevalence rates ranging from 7–28.8% [ 14 ]. This suggests an increasing role for P. aeruginosa in orthopedic implant infections, meriting further investigation into its specific risk factors. Bacterial Profile Across Phases of Implant Infection This study demonstrated a diverse bacterial profile across all phases of orthopedic implant infection. The delayed phase accounted for the highest proportion of isolates (50.7%), followed by early phase (47.7%) and the late phase (1.6%). Klebsiella pneumoniae was the most frequently isolated organism, predominantly found in both early (38.6% cases) and delayed (61.4%) phases, indicating its role in both acute and persistent infections. Escherichia coli was also commonly isolated, with 54.4% of the cases in the early phase, 40% in the delayed phase, and 5.7% in the late phase, suggesting its persistence throughout as infection progresses. Pseudomonas aeruginosa appeared in both early (39.4%) and delayed (60.6%) phases, suggesting also its persistence in implant-related infections. Citrobacter freundii was more prevalent in the early phase (75%) compared to the delayed phase (25%). Other bacteria species, such as Proteus mirabilis (62.5% early, 37.5% delayed), and Providencia stuartii (66.7% delayed, 33.3% late) contributed to infection, but were present at lower frequencies. Klebsiella oxytoca (100% early), and Raoultella ornithinolytica (100% delayed) were isolated less frequently, suggesting a limited role in implant-related infections. These findings are consistent with a study conducted in the UK [ 21 ], which found no significant variations in bacterial species across different infection phases. Antibiotic Response Patterns Associated with Orthopedic Implant Infection The observed peaks in resistance suggest possible antibiotic overuse or development of adaptive resistance mechanisms in bacteria, both of which complicate treatment. Conversely, peaks in sensitivity for certain antibiotics highlight viable therapeutic options, while low sensitivity rates indicate emerging resistance trends that may necessitate alternative therapies. These findings highlight the importance of antibiotic stewardship and the need for more targeted treatment approaches to minimize resistance development and improve patient outcomes. High resistance rates were observed for Ampicillin, Penicillin, Vancomycin, and cephalosporins, including Cefazolin, Cefixime, Ceftriaxone, and Ceftazidime, indicating that these antibiotics are largely ineffective against many of the isolates including Klebsiella pneumoniae and Klebsiella oxytoca ; highlighting their multidrug-resistant nature. For example, high Vancomycin resistance has been associated with its lack of ability to pass the outer membrane of Gram-negative bacteria[ 22 ]. These findings were consistent with a study conducted at Kenyatta National Hospital by Sheikh, (2022)[ 5 ], which also reported resistance to Vancomycin, Ampicillin and Cephalosporins such as ceftriaxone among organisms causing orthopedic implant-related infections. In contrast, Amikacin, Meropenem and Piperacillin-tazobactam demonstrated the highest sensitivity rates across multiple bacterial isolates, suggesting they are among the most effective antibiotics for treating implant-related infections. These findings align with those of a study by Markus et al. , 2021 [ 23 ]which identified these three antibiotics as the most effective for managing prosthetic joint infections (PJIs) and fracture-related infections (FRIs). Similarly, Thapa et al. , 2021[ 24 ] also supported their use as part of standard clinical practice in the treatment of orthopedic implant infections. These high frequencies of Klebsiella pneumoniae in orthopedic implant infections in this study may be attributed to the emergence of multi-drug-resistant (MDR) strains. These strains have been linked to hospital outbreaks and are recognized as an urgent threat to public health [ 25 ]. Their resistance mechanisms primarily have been known to involve production of extended-spectrum β -lactamases (ESBLs) and the expression of carbapenemases [ 8 ].In our study, MDR K. pneumoniae exhibited resistance to multiple antibiotic classes including fluoroquinolones, third-generation cephalosporins, aminoglycosides, and carbapenems [ 26 ]. Additional resistance mechanisms have been reportedly associated with plasmids, transposons, mutations, and biofilm formation [ 27 ]. The increased prevalence of Pseudomonas aeruginosa in orthopedic implant infections may be attributed to multiple factors including patient immunosuppression, hospital environmental exposure, antibiotic resistance, and virulence factors such as its ability to adhere to host cells and invade tissues [ 14 ]. Escherichia coli also demonstrated resistance to several antibiotics, particularly cephalosporins. Studies have shown that Escherichia coli promotes osteoclastic activity while inhibiting osteoblast differentiation, thus making it a challenging pathogen to eliminate. As a result, effective management often require implant removal [ 28 ]. Conclusion This study provides valuable insight into the dominance of Gram-negative bacteria as major causative agents of in orthopedic implant infections. This trend may indicate a shift from the traditionally predominant Staphylococcus aureus , which could be attributed to the current practices of managing orthopedic surgical wounds postoperatively. The findings highlight the importance of understanding the local bacterial ecology in orthopedic implant infection, as a broad spectrum of pathogens were identified. The similarity in bacterial profiles across different phases of infection suggests that phase-specific diagnosis may not be necessary. Furthermore, the varied antibiotic response patterns underscore the need for routine, individualized antibiotic sensitivity testing in all patients with orthopedic implant infections, to guide effective and targeted antibiotic selection, and ultimately improve clinical outcomes. While this study advances our understanding of Gram-negative bacterial pathogens in orthopedic implant-related infections, including their distribution across infection phases, and antibiotic resistance profiles, it has some limitations. These include challenges in accurately determining preoperative status and maintaining long-term follow-up of participants. Additionally, as the data were collected from a single county referral hospital, the findings may not fully reflect regional variations in pathogen distribution and resistance patterns. Abbreviations PJIs - Prosthetic Joint Infections FRIs - Fracture Related Infections SSI - Surgical site infection CLSI - Clinical and Laboratory Standards Institute AMR - Antimicrobial resistance MDR - Multiple Drug Resistance Declarations Ethical approval and considerations. Ethical approval for this study was obtained from Kakamega County Teaching and Referral Hospital Ethics and Research Committee (KCTRH ERC/260/08/2024) and the Maseno University Ethics Review Committee (MUERC/01385/24). A research permit was granted by the National Commission for Science, Technology and Innovation (NACOSTI/P/24/38713). Informed consent was obtained from all adult participants, and assent was obtained from minors. Access to participant data was restricted to the Principal Investigator, and coded identifiers were used to ensure confidentiality and protect participant privacy. Funding None Author contributions SM1, LO1, JK1 and OH2 conceived the research topic and designed the study. All authors (SM1, LO1, JK1 and OH2) participated in data acquisition, analysis and interpretation. All authors reviewed and approved the manuscript. Acknowledgments We thank the study participants and the staff of Kakamega County Teaching and Referral Hospital, Kenya, for their assistance with sample collection and for granting institutional approval for this study. Competing interests The authors declare that they have no competing interests. References Current and novel diagnostics for orthopedic implant biofilm infections: a review. Accessed: Jun. 14, 2025. [Online]. Available: http://ouci.dntb.gov.ua/en/works/lRj1yBWl/ Kargupta R et al (2014) Coatings and surface modifications imparting antimicrobial activity to orthopedic implants. Wiley Interdiscip Rev Nanomed Nanobiotechnol 6(5):475–495. 10.1002/wnan.1273 Tokarski A, Courtney PM, Deirmengian C, Kwan S, McCahon J, Deirmengian GK (Mar. 2023) Systemic Manifestation of Periprosthetic Joint Infection Is Associated With Increased In-Hospital Mortality. Cureus 15(3):e36572. 10.7759/cureus.36572 Metsemakers W-J et al (Dec. 2017) Prevention of fracture-related infection: a multidisciplinary care package. Int Orthop 41(12):2457–2469. 10.1007/s00264-017-3607-y Sheikh MA, Prevalence R, Factors, and Microbiological Profile of Early Surgical Site Infection Following Orthopaedic Implant Surgery at Kenyatta National Hospital (2022), Thesis, University of Nairobi, Accessed: Jun. 14, 2025. [Online]. Available: http://erepository.uonbi.ac.ke/handle/11295/161914 Ribeiro M, Monteiro FJ, Ferraz MP (2012) Infection of orthopedic implants with emphasis on bacterial adhesion process and techniques used in studying bacterial-material interactions. Biomatter 2(4):176–194. 10.4161/biom.22905 Chebli D, Dhaif F, Ridha A, Schade A, Khatri C (2024) A meta-analysis of the incidence of infections following open tibia fractures and the microorganisms that cause them in high-, middle- and low-income countries, Trop. Doct. , vol. 54, no. 3, pp. 272–281, Jul. 10.1177/00494755241232171 Sarkar K, Mullan S, Menon H (Oct. 2024) Exploring Drug Resistance: Microbial Profiles, Antibiotic Sensitivity, and Biofilm Development in Orthopedic Implant Infections. Cureus 16(10):e70938. 10.7759/cureus.70938 Silva R, Salles MC, Matosa R, Ayres B, Dias V, Caetano LM (Oct. 2017) Orthopedic-Implant Associated Infection due to Gram-Negative Bacilli: The Worrisome Impact of Acinetobacter baumannii Multidrug Resistance in a Brazilian Center. Open Forum Infect Dis 4(1):S111–S112. 10.1093/ofid/ofx163.121 Narendrakumar L, Chakraborty M, Kumari S, Paul D, Das B (Mar. 2023) β-Lactam potentiators to re-sensitize resistant pathogens: Discovery, development, clinical use and the way forward. Front Microbiol 13. 10.3389/fmicb.2022.1092556 Zachariah OH, Lizzy MA, Rose K, Angela MM (Jan. 2021) Multiple drug resistance of Campylobacter jejuni and Shigella isolated from diarrhoeic children at Kapsabet County referral hospital, Kenya. BMC Infect Dis 21(1):109. 10.1186/s12879-021-05788-3 Nandakumar V, Chittaranjan S, Kurian VM, Doble M (Feb. 2013) Characteristics of bacterial biofilm associated with implant material in clinical practice. Polym J 45(2):137–152. 10.1038/pj.2012.130 Baertl S et al (Mar. 2022) What Is the Most Effective Empirical Antibiotic Treatment for Early, Delayed, and Late Fracture-Related Infections? Antibiotics 11(3):287. 10.3390/antibiotics11030287 Lumbe H Prevalence and Risk Factors Associated with Implant Infections in Orthopedic Surgeries at Songea Regional Referral Hospital, Tanzania, 7, no. 11 Fischer M et al (2024) Case Report: Hip arthroplasty after fracture-related joint infection caused by extensively drug-resistant Klebsiella pneumoniae. Front Surg 11:1363298. 10.3389/fsurg.2024.1363298 Alelign D et al (2022) Bacteriological Profiles, Antimicrobial Susceptibility Patterns, and Associated Factors in Patients Undergoing Orthopedic Surgery with Suspicion of Surgical Site Infection at Arba Minch General Hospital in Southern Ethiopia. Infect Drug Resist 15:2427–2443. 10.2147/IDR.S367510 Prevalence and distribution of adhesins and the expression of fibronectin-binding protein (FnbA and FnbB) among Staphylococcus aureus isolates from Shahrekord Hospitals | BMC Research Notes | Full Text. Accessed: Jun. 14, 2025. [Online]. Available: https://bmcresnotes.biomedcentral.com/articles/ 10.1186/s13104-019-4055-0 Kasimova AR et al (2024) Twelve-Year Dynamics of Leading Pathogens Spectrum Causing Orthopedic Infection: A Retrospective Study, Traumatol. Orthop. Russ. , vol. 30, no. 1, Art. no. 1, Mar. 10.17816/2311-2905-16720 Sebastian S et al (Sep. 2021) Different microbial and resistance patterns in primary total knee arthroplasty infections - a report on 283 patients from Lithuania and Sweden. BMC Musculoskelet Disord 22(1):800. 10.1186/s12891-021-04689-5 Mengesha MG et al (2024) Sep., Orthopedic postoperative infection profile and antibiotic sensitivity of 2038 patients across 24 countries - Call for region and institution specific surgical antimicrobial prophylaxis, J. Orthop. , vol. 55, pp. 97–104. 10.1016/j.jor.2024.04.018 Masson E Letter in response to article in journal of infection: ‘The microbiology of chronic osteomyelitis: Changes over ten years,’ EM-Consulte. Accessed: Jun. 14, 2025. [Online]. Available: https://www.em-consulte.com/article/1491000/letter-in-response-to-article-in-journal-of-infect van Groesen E, Slingerland CJ, Innocenti P, Mihajlovic M, Masereeuw R, Martin NI (2021) Vancomyxins: Vancomycin-Polymyxin Nonapeptide Conjugates That Retain Anti-Gram-Positive Activity with Enhanced Potency against Gram-Negative Strains, ACS Infect. Dis. , vol. 7, no. 9, pp. 2746–2754, Sep. 10.1021/acsinfecdis.1c00318 Rupp M, Baertl S, Walter N, Hitzenbichler F, Ehrenschwender M, Alt V (2021) Is There a Difference in Microbiological Epidemiology and Effective Empiric Antimicrobial Therapy Comparing Fracture-Related Infection and Periprosthetic Joint Infection? A Retrospective Comparative Study, Antibiot. Basel Switz. , vol. 10, no. 8, p. 921, Jul. 10.3390/antibiotics10080921 Staphylococcus aureus with inducible clindamycin resistance and methicillin resistance in a tertiary hospital in Nepal | Tropical Medicine and Health | Full Text. Accessed: Jun. 14, 2025. [Online]. Available: https://tropmedhealth.biomedcentral.com/articles/ 10.1186/s41182-021-00392-2 Oche DA, Oyegoke PI, Akpudo MO, Olayinka BO (2021) Antibiotics Resistance Pattern of Staphylococcus aureus Isolated From In-patients of an Orthopaedic Hospital in North-Western Nigeria, Int. J. Epidemiol. Res. , vol. 8, no. 4, pp. 160–166, Nov. 10.34172/ijer.2021.29 de Sanctis J et al (Aug. 2014) Complex prosthetic joint infections due to carbapenemase-producing Klebsiella pneumoniae: a unique challenge in the era of untreatable infections. Int J Infect Dis IJID Off Publ Int Soc Infect Dis 25:73–78. 10.1016/j.ijid.2014.01.028 Patel KH et al (Aug. 2023) Microbiological Profile of Fracture Related Infection at a UK Major Trauma Centre. Antibiot Basel Switz 12(9):1358. 10.3390/antibiotics12091358 Crémet L et al (2015) Pathogenic potential of Escherichia coli clinical strains from orthopedic implant infections towards human osteoblastic cells, Pathog. Dis. , vol. 73, no. 8, p. ftv065, Nov. 10.1093/femspd/ftv065 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7436707","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":504348324,"identity":"8d6f60ae-0b80-4971-9abb-344a9fea75cd","order_by":0,"name":"Okemwa Sophia Moraa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYDADA2YGhgMfgAw2UrQwPpxBmhYGBmZjHmJU6rb3Pvzw449Nnjk78zNpm1/b5PkYmB8+uoFHi9mZ48aSvW1pxZbNbGbSuX23DdsY2IyNc/BpuZHGIMHbcDhxw2EGoJae24xtDDxs0gS0MP/88wekhf2btGXPbXtitLBJ87CBtPAYGzP8uJ1IWMuZY2zWskC/GBzmKXzY23A7uY2ZkF+OtzHffAMMMYPzxzcc+PHntu389uaHj/FpgYEEMAn0OzB6iFCO0MLwh0jlo2AUjIJRMKIAAB5uThLlijQLAAAAAElFTkSuQmCC","orcid":"","institution":"Maseno University, Kenya","correspondingAuthor":true,"prefix":"","firstName":"Okemwa","middleName":"Sophia","lastName":"Moraa","suffix":""},{"id":504348369,"identity":"11719ae7-dbb3-44f4-979e-4ed8afe16291","order_by":1,"name":"Lilian Ogonda","email":"","orcid":"","institution":"Maseno University, Kenya","correspondingAuthor":false,"prefix":"","firstName":"Lilian","middleName":"","lastName":"Ogonda","suffix":""},{"id":504348370,"identity":"76d9b4b7-24cb-4736-9298-6421ee1ceb49","order_by":2,"name":"James Kombok","email":"","orcid":"","institution":"Maseno University, Kenya","correspondingAuthor":false,"prefix":"","firstName":"James","middleName":"","lastName":"Kombok","suffix":""},{"id":504348371,"identity":"e63fdab9-68d7-4ded-851e-4c86ad4b4c95","order_by":3,"name":"Ongwae H. Zachariah","email":"","orcid":"","institution":"University of Eldoret, Kenya","correspondingAuthor":false,"prefix":"","firstName":"Ongwae","middleName":"H.","lastName":"Zachariah","suffix":""}],"badges":[],"createdAt":"2025-08-22 17:59:55","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7436707/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7436707/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89994935,"identity":"59c234e0-0e29-4fe2-a885-d9b8a4ec85b3","added_by":"auto","created_at":"2025-08-27 07:53:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":105747,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eGraph 1: Bar graph showing resistance patterns of bacterial isolates to various antibiotics\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7436707/v1/9b075a064da4d3ca097ea5d3.png"},{"id":89993569,"identity":"b79ed4c1-7a2f-47f8-914f-a74b0e59ac15","added_by":"auto","created_at":"2025-08-27 07:45:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":91335,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eGraph 2: Bar graph showing sensitivity patterns of bacterial isolates to various antibiotics\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7436707/v1/13d9d74dcdd5ebee2e9eddf5.png"},{"id":89995941,"identity":"be89493b-fcfb-4959-8705-9e008aa6d22d","added_by":"auto","created_at":"2025-08-27 08:01:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1283471,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7436707/v1/d16160d7-f1dc-4c9a-986b-a9658350f864.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003ePredominance of Gram-Negative Bacteria and Their Antibiotic Resistance Profiles in Orthopedic Implant Infections at a Tertiary Hospital in Kenya\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eInfections involving orthopedic implants are a major complication following surgical fixation or joint replacement procedures[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] .They contribute significantly to repeated surgical interventions, extended antibiotic therapy, prolonged morbidity, and substantial economic burden on both patients and healthcare systems[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These infections are difficult to treat due to formation of bacterial biofilm on implant surfaces, which confer resistance to host immune responses and reduce the efficacy of antibiotics [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].The mortality rate due to Prosthetic Joint Infections (PJI) ranges from 0.4\u0026ndash;7% in geriatric patients aged 65 to 80 years old [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Fracture-related infections (FRI) occur in approximately 1\u0026ndash;2% of closed fractures requiring internal fixation and in up to 30% of open fractures, such as tibial fractures[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn Kenya, the overall infection rate following orthopedic implantation procedures is estimated at approximately 13.8%, although this figure is likely underestimated due to a lack of standardized surveillance protocols for detecting implant-related infections[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. At Kakamega County Teaching and Referral Hospital (KCTRH), hospital records indicated that approximately 18% of orthopedic patients returned with suspected implant infections. However, most of these cases were managed empirically without microbiological confirmation, primarily due to financial constraints that limited access to culture and sensitivity testing (Outpatient Quarterly Morbidity Report, 2023).\u003c/p\u003e\u003cp\u003eGlobally, most studies on orthopedic implant infections have focused on Gram-positive bacteria, particularly \u003cem\u003eStaphylococcus aureus\u003c/em\u003e, which is widely recognized as the predominant etiological agent [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, emerging evidence indicates an increasing involvement of Gram-negative bacteria, such as \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e, \u003cem\u003eEscherichia coli\u003c/em\u003e and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e, as common etiological agents in these infections, especially in low- and middle-income countries (LMICs) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. For instance, Sarkar \u003cem\u003eet al.\u003c/em\u003e (2024)[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] reported that 68% of isolates from orthopedic implant infections in a tertiary care hospital in India were Gram-negative, with most exhibiting high biofilm formation and multidrug resistance [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Similarly, a study from Brazil found that 57.3% of implant related infections were caused by Gram \u0026ndash;negative bacteria, with \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e accounting for 14.9% of cases[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThese Gram-negative bacteria frequently exhibit resistance to multiple antibiotic classes, including cephalosporins, aminoglycosides, and fluoroquinolones, and in some cases, carbapenems, posing significant therapeutic challenges [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Despite their clinical importance, region-specific data on the diversity of bacterial species and their antibiotic resistance profiles in orthopedic implant infections remain limited, particularly in low- and middle-income countries such as Kenya. The inappropriate and widespread use of antibiotics has driven the emergence of resistant pathogens, leaving few or sometimes no effective agents to treat infections they cause [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOrthopedic implant-associated infections are typically classified based on the time of onset into early (\u0026lt;\u0026thinsp;2 weeks post-surgery), delayed (2\u0026ndash;10 weeks), and late infections (\u0026gt;\u0026thinsp;10 weeks)[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, there is ambiguity regarding whether this timing refers to time interval from the initial injury, the implant fixation, or the onset of clinical symptoms, and which, if any, is clinically relevant. This classification is widely adopted though, as it is likely to influence treatment decisions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Recent analysis of the bacteriological etiology in fracture-related infections and prosthetic joint infections suggest that a similar bacterial profile may be present across all three phases[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTherefore, this study aimed to characterize the bacterial species responsible for orthopedic implant-related infections at a tertiary hospital in western Kenya, analyze the bacterial profile at the various phases of infection and to determine their antimicrobial resistance profiles. The findings are intended to inform evidence-based clinical management and support the development of more effective infection prevention and treatment strategies in similar resource-limited healthcare settings.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and study area\u003c/h2\u003e\u003cp\u003eA cross-sectional study was conducted at Kakamega County teaching and referral hospital between August 2024 and March 2025. This Level 5 hospital serves as the primary referral center for Kakamega County and neighboring regions. Motorcycle accidents are a major cause of trauma-related injuries in this area, contributing significantly to the burden of orthopedic cases (Outpatient Quarterly Morbidity Report, 2023).\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy population, sample size and sampling technique.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study population consisted of patients presenting with implant-related surgical site infections following orthopedic surgery at Kakamega County Teaching and Referral Hospital. A purposive sampling technique was employed. The sample size of 191 participants was calculated using the formula described by Fisher \u003cem\u003eet al\u003c/em\u003e. (1999) and adjusted using the finite population correction formula.\u003c/p\u003e\u003cp\u003eData was collected at the orthopedic outpatient clinic and inpatient wards, as well as intraoperatively during surgical interventions from consecutive patients with implant-related surgical site infections.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData collection procedures\u003c/h3\u003e\n\u003cp\u003eData was collected using a structured questionnaire to obtain baseline demographic information.\u003c/p\u003e\u003cp\u003ePus swabs were collected after cleaning the infection site with normal saline to remove necrotic tissue, dry exudates and dressing residues. The samples were immediately transferred to the hospital\u0026rsquo;s microbiology laboratory using Amies transport medium. Direct smears were prepared for Gram staining.\u003c/p\u003e\u003cp\u003eStandard culturing was performed on blood agar (incubated anaerobically at 37\u0026deg;C for 24 hours), Chocolate agar (incubated anaerobically at 37\u0026deg;C for 24 hours) and MacConkey agar with crystal violet (incubated aerobically at 37\u0026deg;C for 24 hours). Purity plating was done on the cultured bacteria to isolate pure cultures.\u003c/p\u003e\u003cp\u003eBacteria identification and antimicrobial susceptibility testing were carried using the VITEK 2 system. Stock cultures of \u003cem\u003eStaphylococcus aureus\u003c/em\u003e ATCC 25923 and \u003cem\u003eEscherichia coli\u003c/em\u003e ATCC 25922 were used as control strains.\u003c/p\u003e\n\u003ch3\u003eData management and analysis\u003c/h3\u003e\n\u003cp\u003eThe data was organized and managed using Epi Info version 3.4.3. Statistical analysis was performed using SPSS version 25. Descriptive statistics were used to summarize data on bacterial isolates, and antimicrobial susceptibility patterns.\u003c/p\u003e"},{"header":"Results and Discussion","content":"\u003cp\u003e\u003cstrong\u003eDemographic characteristics of participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in table 1 below, the distribution of age ranges from under 18 years to above 73 years. The gender distribution of the participants indicates that 126 (66.0%) were male and 65 (34.0%) were female. The data reveals a higher prevalence of male participants in the study. Most\u0026nbsp;of the participants (65.4%) reported no comorbidities. Among those with comorbidities, diabetes and hypertension were the most common, each accounting for 16.2% and 16.7% of the participants. Other comorbid conditions, such as alcoholism, diabetes combined with hypertension, and hypertension combined with prostatectomy, were reported at much lower frequencies (0.5% each). This distribution highlights that while some participants have specific health conditions, the majority are free of comorbidities. The types of injuries among the participants varied significantly, with fractures being the most prevalent. Femur fractures were the most common, accounting for 37.7% of cases, followed closely by tibia fractures (34.0%). Other notable injuries included ulna fractures (15.7%) and pelvic fractures (10.5%). Less frequent injuries such as fibular fractures (1.6%) and humerus fractures (0.5%) were observed in a small proportion of cases. The data indicate a predominance of bone fractures, highlighting the severity of injuries experienced by the participants. The use of different types of implants among the participants varied, with external fixation (exofix) being the most common, used in 37.2% of cases. Pins and wires followed closely, accounting for 35.1% of the implant types. Plates were used in 25.7% of cases, indicating a significant reliance on these devices for injury management. Implant removal was relatively rare, occurring in only 2.1% of cases.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTable 1: Demographic and Clinical Characteristics of Participants\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"435\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026le; 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e5.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e19-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e20.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e30-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e31.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e41-51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e26.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e52-62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e13.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026ge; 73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e3.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e66.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e34.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eDiabetes and Hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eHypertension and Prostatectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eAlcoholism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e16.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e16.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e65.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInjury Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eHumerus fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eFibular fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e1.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003ePelvic fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e10.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eUlna fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e15.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eTibia fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e34.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eFemur fracture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e37.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 153px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImplants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eImplant removal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e2.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003ePlate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e25.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003ePins and wires\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e35.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eExofix\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e37.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eCommon\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003cstrong\u003eacterial\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eS\u003c/strong\u003e\u003cstrong\u003epecies\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eR\u003c/strong\u003e\u003cstrong\u003eesponsible for\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eO\u003c/strong\u003e\u003cstrong\u003erthopedic\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eI\u003c/strong\u003e\u003cstrong\u003emplant\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eI\u003c/strong\u003e\u003cstrong\u003enfection\u003c/strong\u003e\u003cstrong\u003es\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in table 2, a variety of Gram-negative bacteria were isolated from participants with implant-related infections. \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e was the most frequently isolated species, accounting for 29.2% of the isolates. Other common bacteria included \u003cem\u003eEscherichia coli\u003c/em\u003e (17.9%), and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (16.9%). \u003cem\u003eCitrobacter freundii\u0026nbsp;\u003c/em\u003eand \u003cem\u003eProteus mirabilis\u0026nbsp;\u003c/em\u003ewere also notable, accounting for 10.3% and 4.1% of isolates, respectively. Less frequently isolated species included \u003cem\u003eProvidencia stuartii, Raoultella ornithinolytica,\u003c/em\u003e and \u003cem\u003eKlebsiella oxytoca,\u003c/em\u003e each comprising less than 2.0% of the isolates.\u003cem\u003e\u0026nbsp;Staphylococcus aureus\u003c/em\u003e (14.9%) and \u003cem\u003eStaphylococcus epidermidis\u0026nbsp;\u003c/em\u003e(2.1%) were the only Gram-positive species isolated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Bacteria Isolated from Implant-Related Infections\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"445\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBACTERIA ISOLATED\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e29.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cem\u003eE.Coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e17.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cem\u003eP. aeruginosa\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cem\u003eStaphylococcus aureus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cem\u003eCitrobacter freundii\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cem\u003eProteus mirabillis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cem\u003eS. epidermidis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cem\u003eProvidencia stuartii\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cem\u003eRaoultella ornithinolytica\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cem\u003eKlebsiella oxyotoca\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 174px;\"\u003e\n \u003cp\u003eNo bacteria growth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e195\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eBacterial profile at the\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eV\u003c/strong\u003e\u003cstrong\u003earious\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003cstrong\u003ehases of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eI\u003c/strong\u003e\u003cstrong\u003emplant\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eI\u003c/strong\u003e\u003cstrong\u003enfection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 presents the distribution of bacterial species across the different phases of implant-related infections, highlighting variations in pathogen prevalence at each stage.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e was the most frequently isolated pathogen, predominantly found in the early phase (38.6% of its isolates) and the delayed phase (61.4%). \u003cem\u003eEscherichia coli\u0026nbsp;\u003c/em\u003ewas also prevalent, with 54.3% of the isolates identified in the early phase, 40.0% in the delayed phase, and 5.7% in the late phase. \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e was isolated in both early (39.4% of the cases) and delayed (60.6% of the cases) phases.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCitrobacter freundii\u0026nbsp;\u003c/em\u003ewas primarily present in the early phase (75.0%) and to a lesser extent in the delayed phase (25.0%). Other less frequently isolated species included \u003cem\u003eProteus mirabilis\u003c/em\u003e (62.5% early, 37.5% delayed), \u003cem\u003eProvidencia stuarti\u003c/em\u003e (66.7% delayed, 33.3% late), \u003cem\u003eKlebsiella oxytoca\u003c/em\u003e (100% early), and \u003cem\u003eRaoultella ornithinolytica\u003c/em\u003e (100% delayed).\u003c/p\u003e\n\u003cp\u003eThe late phase showed minimal bacterial presence, with only two isolates: one \u003cem\u003eEscherichia coli and\u0026nbsp;\u003c/em\u003eone \u003cem\u003eProvidencia stuartii\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: \u0026nbsp; Distribution of Bacteria Isolated Across Phases of Implant-Related Infection\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"607\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 305px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePHASE OF INFECTION\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBACTERIA ISOLATED\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDelayed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e22 (38.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e35 (61.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cem\u003eEscherichia coli\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e19 (54.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e14 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e2 (5.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e13 (39.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e20 (60.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cem\u003eStaphylococcus aureus\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e12 (41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e17 (58.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cem\u003eCitrobacter freundii\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e15 (75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e5 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0(0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cem\u003eProteus mirabilis\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e5 (62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e3 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cem\u003eStaphylococcus epidermidis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e4 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cem\u003eProvidencia stuartii\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e2 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e1 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cem\u003eKlebsiella oxytoca\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e2 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cem\u003eRaoultella ornithinolytica\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e2 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e92 (47.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e98 (50.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 90px;\"\u003e\n \u003cp\u003e3 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAntibiotic Response Patterns Associated with Orthopedic Implant Infections\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 4 summarizes the antibiotic susceptibility profiles of all the bacterial isolates obtained from orthopedic implant infections. The responses are categorized as Resistant (R), Sensitive (S), and Intermediate (I).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSusceptibility testing revealed widespread multidrug resistance to commonly used antibiotics. All isolates (100%) were resistant to penicillin, while high resistance rates were also observed for ceftriaxone (97.9%), cefazolin (96%), cefotaxime (88.2%), ampicillin (85%), and vancomycin (84.6%). These findings highlight the limited efficacy of vancomycin, as well as\u0026nbsp;b-lactam antibiotics, including first- and second-generation cephalosporins in the treatment of implant-related infections in this setting.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn contrast, amikacin demonstrated the highest sensitivity rate, with 98% of isolates susceptible, followed by meropenem (84.1%), and\u0026nbsp;piperacillin-tazobactam (69.2%), indicating their potential effectiveness in treating these infections. Resistance to ciprofloxacin (49.7%), clindamycin (48.2%) and gentamicin (28.7%) was considerable, though lower than that observed with\u0026nbsp;b-lactam antibiotics.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable 4: Antibiotic Response Patterns versus their response to all bacterial isolates\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"591\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResponse/ percentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntibiotic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResistant\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSensitive\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntermediate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003ePenicillin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eCeftriaxone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e97.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eCefazolin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eAmoxyclav\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e93.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eCefotaxime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e88.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eCeftazidime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e85.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eAmpicillin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eVancomycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e84.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e15.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eCefixime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e33.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eCiprofloxacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e49.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e46.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eClindamycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e48.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e50.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eErythromycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e48.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e50.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eCefoxitin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e38.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e61.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003ePiperacillin-tazo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e30.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e69.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eGentamycin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e28.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e58.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e12.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eMeropenem\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e84.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eAmikacin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 60px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAntibiogram Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGraph 1 illustrates the antibiotic resistance patterns observed among the bacterial species isolated from orthopedic implant infections. High resistance rates were noted for ampicillin, penicillin, vancomycin, and cephalosporins, including Cefazolin, Cefixime, Ceftriaxone, and Ceftazidime. \u003cem\u003eKlebsiella pneumoniae\u0026nbsp;\u003c/em\u003edemonstrated broad resistance across multiple antibiotic classes. In contrast, resistance rate was low for piperacillin-tazobactam, Amikacin, and meropenem, indicating their potential efficacy in this clinical setting.\u003c/p\u003e\n\u003cp\u003eGraph 2 presents the antibiotic sensitivity patterns of the same bacterial species. Amikacin, meropenem, and piperacillin-tazobactam show the highest sensitivity across multiple isolates. In contrast, ampicillin, penicillin, and vancomycin demonstrated low sensitivity rates. Both \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e and \u003cem\u003eKlebsiella oxytoca\u003c/em\u003e exhibited resistance to most cephalosporins but retained sensitivity to aminoglycosides, particularly amikacin. These patterns highlight the importance of local antibiogram data in guiding empirical antibiotic therapy.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eDemographics\u003c/h2\u003e\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eParticipants age captured a diverse age distribution. However, participants aged between 30 to 40 years old were most affected at 31.4%. 66% of the participants were male while 34% were female suggesting higher prevalence of men getting orthopedic implant infections. These phenomena are attributed to increased exposure to risk factors according to Lumbe et al. (2024) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. 65% of the participants were free of any comorbidities while those with diabetes were 16.2%, hypertension 16.7%, lower frequencies at 0.5% each was seen for hypertension combined with diabetes, with prostatectomy and in alcoholism. This distribution highlights that while some participants were free of any comorbidities many have specific health conditions hence a necessity to have tailored interventions as well as prevention measures. All participants in the study had bone fractures as the cause of injury and none had implants due to joint replacements. Femur fractures at 37.7% of cases, tibia fractures 34.0%, ulna fractures 15.7%, pelvic fractures 10.5%, fibular fractures1.6% and humerus fractures 0.5% aligning with data from similar studies Lumbe et al. (2024)[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The data suggests a diverse use of implants, with a notable preference for external fixation and pins and wires in treating injuries. Exofix was used in 37.2% of cases, Pins and wires in 35.1%, Plates in 25.7% of cases while 2.1% of the cases were implant removals as interventions in cases of implant failure due to infections.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eCommon Bacterial Species Responsible for Orthopedic Implant Infections\u003c/h2\u003e\u003cp\u003eThis study revealed the presence of diverse Gram-negative bacterial species among participants with orthopedic implant infections. \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e was the most frequently isolated pathogen, although other bacterial species also played a role. This Gram-negative enterobacterium is increasingly associated with severe infections and high mortality rates [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] .The distribution of these organisms is influenced by a variety of epidemiological factors including host-related conditions and perioperative practices [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].Other contributing factors may include delayed fracture healing, post-surgical trauma, sepsis and contamination at the surgical sites[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur findings are consistent with studies showing an upward trend in Gram-negative bacterial involvement in orthopedic implant-related infections. For instance, a study in Russia reported an increase in Gram-negatives isolates from 25\u0026ndash;33% [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Similar trends were observed in Sweden and Lithuania, where Gram-negative pathogens dominated implant-related infections [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]Studies in West Africa[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and India[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] also reported a higher prevalence of Gram-negative bacteria compared to Gram-positives. In our study, \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e was also isolated in 16.9% of cases, aligning with previously reported prevalence rates ranging from 7\u0026ndash;28.8% [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This suggests an increasing role for \u003cem\u003eP. aeruginosa\u003c/em\u003e in orthopedic implant infections, meriting further investigation into its specific risk factors.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eBacterial Profile Across Phases of Implant Infection\u003c/h2\u003e\u003cp\u003eThis study demonstrated a diverse bacterial profile across all phases of orthopedic implant infection. The delayed phase accounted for the highest proportion of isolates (50.7%), followed by early phase (47.7%) and the late phase (1.6%). \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e was the most frequently isolated organism, predominantly found in both early (38.6% cases) and delayed (61.4%) phases, indicating its role in both acute and persistent infections. \u003cem\u003eEscherichia coli\u003c/em\u003e was also commonly isolated, with 54.4% of the cases in the early phase, 40% in the delayed phase, and 5.7% in the late phase, suggesting its persistence throughout as infection progresses. \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e appeared in both early (39.4%) and delayed (60.6%) phases, suggesting also its persistence in implant-related infections.\u003c/p\u003e\u003cp\u003e\u003cem\u003eCitrobacter freundii\u003c/em\u003e was more prevalent in the early phase (75%) compared to the delayed phase (25%). Other bacteria species, such as \u003cem\u003eProteus mirabilis\u003c/em\u003e (62.5% early, 37.5% delayed), and \u003cem\u003eProvidencia stuartii\u003c/em\u003e (66.7% delayed, 33.3% late) contributed to infection, but were present at lower frequencies. \u003cem\u003eKlebsiella oxytoca\u003c/em\u003e (100% early), and \u003cem\u003eRaoultella ornithinolytica\u003c/em\u003e (100% delayed) were isolated less frequently, suggesting a limited role in implant-related infections. These findings are consistent with a study conducted in the UK [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], which found no significant variations in bacterial species across different infection phases.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eAntibiotic Response Patterns Associated with Orthopedic Implant Infection\u003c/h2\u003e\u003cp\u003eThe observed peaks in resistance suggest possible antibiotic overuse or development of adaptive resistance mechanisms in bacteria, both of which complicate treatment. Conversely, peaks in sensitivity for certain antibiotics highlight viable therapeutic options, while low sensitivity rates indicate emerging resistance trends that may necessitate alternative therapies. These findings highlight the importance of antibiotic stewardship and the need for more targeted treatment approaches to minimize resistance development and improve patient outcomes.\u003c/p\u003e\u003cp\u003eHigh resistance rates were observed for Ampicillin, Penicillin, Vancomycin, and cephalosporins, including Cefazolin, Cefixime, Ceftriaxone, and Ceftazidime, indicating that these antibiotics are largely ineffective against many of the isolates including \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e and \u003cem\u003eKlebsiella oxytoca\u003c/em\u003e; highlighting their multidrug-resistant nature. For example, high Vancomycin resistance has been associated with its lack of ability to pass the outer membrane of Gram-negative bacteria[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. These findings were consistent with a study conducted at Kenyatta National Hospital by Sheikh, (2022)[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], which also reported resistance to Vancomycin, Ampicillin and Cephalosporins such as ceftriaxone among organisms causing orthopedic implant-related infections.\u003c/p\u003e\u003cp\u003eIn contrast, Amikacin, Meropenem and Piperacillin-tazobactam demonstrated the highest sensitivity rates across multiple bacterial isolates, suggesting they are among the most effective antibiotics for treating implant-related infections. These findings align with those of a study by Markus \u003cem\u003eet al.\u003c/em\u003e, 2021 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]which identified these three antibiotics as the most effective for managing prosthetic joint infections (PJIs) and fracture-related infections (FRIs). Similarly, Thapa \u003cem\u003eet al.\u003c/em\u003e, 2021[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] also supported their use as part of standard clinical practice in the treatment of orthopedic implant infections.\u003c/p\u003e\u003cp\u003eThese high frequencies of \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e in orthopedic implant infections in this study may be attributed to the emergence of multi-drug-resistant (MDR) strains. These strains have been linked to hospital outbreaks and are recognized as an urgent threat to public health [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Their resistance mechanisms primarily have been known to involve production of extended-spectrum \u003cem\u003eβ\u003c/em\u003e-lactamases (ESBLs) and the expression of carbapenemases [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].In our study, MDR \u003cem\u003eK. pneumoniae\u003c/em\u003e exhibited resistance to multiple antibiotic classes including fluoroquinolones, third-generation cephalosporins, aminoglycosides, and carbapenems [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Additional resistance mechanisms have been reportedly associated with plasmids, transposons, mutations, and biofilm formation [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe increased prevalence of \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e in orthopedic implant infections may be attributed to multiple factors including patient immunosuppression, hospital environmental exposure, antibiotic resistance, and virulence factors such as its ability to adhere to host cells and invade tissues [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eEscherichia coli\u003c/em\u003e also demonstrated resistance to several antibiotics, particularly cephalosporins. Studies have shown that \u003cem\u003eEscherichia coli\u003c/em\u003e promotes osteoclastic activity while inhibiting osteoblast differentiation, thus making it a challenging pathogen to eliminate. As a result, effective management often require implant removal [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides valuable insight into the dominance of Gram-negative bacteria as major causative agents of in orthopedic implant infections. This trend may indicate a shift from the traditionally predominant \u003cem\u003eStaphylococcus aureus\u003c/em\u003e, which could be attributed to the current practices of managing orthopedic surgical wounds postoperatively.\u003c/p\u003e\u003cp\u003eThe findings highlight the importance of understanding the local bacterial ecology in orthopedic implant infection, as a broad spectrum of pathogens were identified. The similarity in bacterial profiles across different phases of infection suggests that phase-specific diagnosis may not be necessary. Furthermore, the varied antibiotic response patterns underscore the need for routine, individualized antibiotic sensitivity testing in all patients with orthopedic implant infections, to guide effective and targeted antibiotic selection, and ultimately improve clinical outcomes.\u003c/p\u003e\u003cp\u003eWhile this study advances our understanding of Gram-negative bacterial pathogens in orthopedic implant-related infections, including their distribution across infection phases, and antibiotic resistance profiles, it has some limitations. These include challenges in accurately determining preoperative status and maintaining long-term follow-up of participants. Additionally, as the data were collected from a single county referral hospital, the findings may not fully reflect regional variations in pathogen distribution and resistance patterns.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003ePJIs\u003c/strong\u003e\u0026nbsp; - Prosthetic Joint Infections\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFRIs\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003e- Fracture Related Infections\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSSI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eSurgical site infection\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCLSI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eClinical and Laboratory Standards Institute\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAMR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;-\u003c/strong\u003e\u0026nbsp; Antimicrobial resistance\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMDR -\u0026nbsp;\u003c/strong\u003eMultiple Drug Resistance\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and considerations.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from Kakamega County Teaching and Referral Hospital\u0026nbsp;Ethics and Research Committee (KCTRH ERC/260/08/2024) and the Maseno University Ethics Review Committee (MUERC/01385/24). A research permit was granted by the National Commission for Science, Technology and Innovation (NACOSTI/P/24/38713). Informed consent was obtained from all adult participants, and assent was obtained from minors. Access to participant data was restricted to the Principal Investigator, and coded identifiers were used to ensure confidentiality and protect participant privacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSM1, LO1, JK1 and OH2 conceived the research topic and designed the study. All authors (SM1, LO1, JK1 and OH2) participated in data acquisition, analysis and interpretation. \u0026nbsp;All authors reviewed and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the study participants and the staff of\u0026nbsp;Kakamega County Teaching and Referral Hospital, Kenya, for their assistance with sample collection and for granting institutional approval for this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCurrent and novel diagnostics for orthopedic implant biofilm infections: a review. Accessed: Jun. 14, 2025. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://ouci.dntb.gov.ua/en/works/lRj1yBWl/\u003c/span\u003e\u003cspan address=\"http://ouci.dntb.gov.ua/en/works/lRj1yBWl/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKargupta R et al (2014) Coatings and surface modifications imparting antimicrobial activity to orthopedic implants. Wiley Interdiscip Rev Nanomed Nanobiotechnol 6(5):475\u0026ndash;495. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/wnan.1273\u003c/span\u003e\u003cspan address=\"10.1002/wnan.1273\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTokarski A, Courtney PM, Deirmengian C, Kwan S, McCahon J, Deirmengian GK (Mar. 2023) Systemic Manifestation of Periprosthetic Joint Infection Is Associated With Increased In-Hospital Mortality. Cureus 15(3):e36572. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.36572\u003c/span\u003e\u003cspan address=\"10.7759/cureus.36572\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMetsemakers W-J et al (Dec. 2017) Prevention of fracture-related infection: a multidisciplinary care package. Int Orthop 41(12):2457\u0026ndash;2469. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00264-017-3607-y\u003c/span\u003e\u003cspan address=\"10.1007/s00264-017-3607-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSheikh MA, Prevalence R, Factors, and Microbiological Profile of Early Surgical Site Infection Following Orthopaedic Implant Surgery at Kenyatta National Hospital (2022), Thesis, University of Nairobi, Accessed: Jun. 14, 2025. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://erepository.uonbi.ac.ke/handle/11295/161914\u003c/span\u003e\u003cspan address=\"http://erepository.uonbi.ac.ke/handle/11295/161914\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRibeiro M, Monteiro FJ, Ferraz MP (2012) Infection of orthopedic implants with emphasis on bacterial adhesion process and techniques used in studying bacterial-material interactions. Biomatter 2(4):176\u0026ndash;194. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4161/biom.22905\u003c/span\u003e\u003cspan address=\"10.4161/biom.22905\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChebli D, Dhaif F, Ridha A, Schade A, Khatri C (2024) A meta-analysis of the incidence of infections following open tibia fractures and the microorganisms that cause them in high-, middle- and low-income countries, \u003cem\u003eTrop. Doct.\u003c/em\u003e, vol. 54, no. 3, pp. 272\u0026ndash;281, Jul. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/00494755241232171\u003c/span\u003e\u003cspan address=\"10.1177/00494755241232171\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSarkar K, Mullan S, Menon H (Oct. 2024) Exploring Drug Resistance: Microbial Profiles, Antibiotic Sensitivity, and Biofilm Development in Orthopedic Implant Infections. Cureus 16(10):e70938. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.70938\u003c/span\u003e\u003cspan address=\"10.7759/cureus.70938\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSilva R, Salles MC, Matosa R, Ayres B, Dias V, Caetano LM (Oct. 2017) Orthopedic-Implant Associated Infection due to Gram-Negative Bacilli: The Worrisome Impact of Acinetobacter baumannii Multidrug Resistance in a Brazilian Center. Open Forum Infect Dis 4(1):S111\u0026ndash;S112. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/ofid/ofx163.121\u003c/span\u003e\u003cspan address=\"10.1093/ofid/ofx163.121\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNarendrakumar L, Chakraborty M, Kumari S, Paul D, Das B (Mar. 2023) β-Lactam potentiators to re-sensitize resistant pathogens: Discovery, development, clinical use and the way forward. Front Microbiol 13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fmicb.2022.1092556\u003c/span\u003e\u003cspan address=\"10.3389/fmicb.2022.1092556\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZachariah OH, Lizzy MA, Rose K, Angela MM (Jan. 2021) Multiple drug resistance of Campylobacter jejuni and Shigella isolated from diarrhoeic children at Kapsabet County referral hospital, Kenya. BMC Infect Dis 21(1):109. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12879-021-05788-3\u003c/span\u003e\u003cspan address=\"10.1186/s12879-021-05788-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNandakumar V, Chittaranjan S, Kurian VM, Doble M (Feb. 2013) Characteristics of bacterial biofilm associated with implant material in clinical practice. Polym J 45(2):137\u0026ndash;152. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/pj.2012.130\u003c/span\u003e\u003cspan address=\"10.1038/pj.2012.130\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBaertl S et al (Mar. 2022) What Is the Most Effective Empirical Antibiotic Treatment for Early, Delayed, and Late Fracture-Related Infections? Antibiotics 11(3):287. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/antibiotics11030287\u003c/span\u003e\u003cspan address=\"10.3390/antibiotics11030287\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLumbe H Prevalence and Risk Factors Associated with Implant Infections in Orthopedic Surgeries at Songea Regional Referral Hospital, Tanzania, 7, no. 11\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFischer M et al (2024) Case Report: Hip arthroplasty after fracture-related joint infection caused by extensively drug-resistant Klebsiella pneumoniae. Front Surg 11:1363298. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fsurg.2024.1363298\u003c/span\u003e\u003cspan address=\"10.3389/fsurg.2024.1363298\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlelign D et al (2022) Bacteriological Profiles, Antimicrobial Susceptibility Patterns, and Associated Factors in Patients Undergoing Orthopedic Surgery with Suspicion of Surgical Site Infection at Arba Minch General Hospital in Southern Ethiopia. Infect Drug Resist 15:2427\u0026ndash;2443. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/IDR.S367510\u003c/span\u003e\u003cspan address=\"10.2147/IDR.S367510\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePrevalence and distribution of adhesins and the expression of fibronectin-binding protein (FnbA and FnbB) among Staphylococcus aureus isolates from Shahrekord Hospitals | BMC Research Notes | Full Text. Accessed: Jun. 14, 2025. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bmcresnotes.biomedcentral.com/articles/\u003c/span\u003e\u003cspan address=\"https://bmcresnotes.biomedcentral.com/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13104-019-4055-0\u003c/span\u003e\u003cspan address=\"10.1186/s13104-019-4055-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKasimova AR et al (2024) Twelve-Year Dynamics of Leading Pathogens Spectrum Causing Orthopedic Infection: A Retrospective Study, \u003cem\u003eTraumatol. Orthop. Russ.\u003c/em\u003e, vol. 30, no. 1, Art. no. 1, Mar. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.17816/2311-2905-16720\u003c/span\u003e\u003cspan address=\"10.17816/2311-2905-16720\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSebastian S et al (Sep. 2021) Different microbial and resistance patterns in primary total knee arthroplasty infections - a report on 283 patients from Lithuania and Sweden. BMC Musculoskelet Disord 22(1):800. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12891-021-04689-5\u003c/span\u003e\u003cspan address=\"10.1186/s12891-021-04689-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMengesha MG et al (2024) Sep., Orthopedic postoperative infection profile and antibiotic sensitivity of 2038 patients across 24 countries - Call for region and institution specific surgical antimicrobial prophylaxis, \u003cem\u003eJ. Orthop.\u003c/em\u003e, vol. 55, pp. 97\u0026ndash;104. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jor.2024.04.018\u003c/span\u003e\u003cspan address=\"10.1016/j.jor.2024.04.018\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMasson E Letter in response to article in journal of infection: \u0026lsquo;The microbiology of chronic osteomyelitis: Changes over ten years,\u0026rsquo; EM-Consulte. Accessed: Jun. 14, 2025. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.em-consulte.com/article/1491000/letter-in-response-to-article-in-journal-of-infect\u003c/span\u003e\u003cspan address=\"https://www.em-consulte.com/article/1491000/letter-in-response-to-article-in-journal-of-infect\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003evan Groesen E, Slingerland CJ, Innocenti P, Mihajlovic M, Masereeuw R, Martin NI (2021) Vancomyxins: Vancomycin-Polymyxin Nonapeptide Conjugates That Retain Anti-Gram-Positive Activity with Enhanced Potency against Gram-Negative Strains, \u003cem\u003eACS Infect. Dis.\u003c/em\u003e, vol. 7, no. 9, pp. 2746\u0026ndash;2754, Sep. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1021/acsinfecdis.1c00318\u003c/span\u003e\u003cspan address=\"10.1021/acsinfecdis.1c00318\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRupp M, Baertl S, Walter N, Hitzenbichler F, Ehrenschwender M, Alt V (2021) Is There a Difference in Microbiological Epidemiology and Effective Empiric Antimicrobial Therapy Comparing Fracture-Related Infection and Periprosthetic Joint Infection? A Retrospective Comparative Study, \u003cem\u003eAntibiot. Basel Switz.\u003c/em\u003e, vol. 10, no. 8, p. 921, Jul. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/antibiotics10080921\u003c/span\u003e\u003cspan address=\"10.3390/antibiotics10080921\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStaphylococcus aureus with inducible clindamycin resistance and methicillin resistance in a tertiary hospital in Nepal | Tropical Medicine and Health | Full Text. Accessed: Jun. 14, 2025. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://tropmedhealth.biomedcentral.com/articles/\u003c/span\u003e\u003cspan address=\"https://tropmedhealth.biomedcentral.com/articles/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s41182-021-00392-2\u003c/span\u003e\u003cspan address=\"10.1186/s41182-021-00392-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOche DA, Oyegoke PI, Akpudo MO, Olayinka BO (2021) Antibiotics Resistance Pattern of \u003cem\u003eStaphylococcus aureus\u003c/em\u003e Isolated From In-patients of an Orthopaedic Hospital in North-Western Nigeria, \u003cem\u003eInt. J. Epidemiol. Res.\u003c/em\u003e, vol. 8, no. 4, pp. 160\u0026ndash;166, Nov. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.34172/ijer.2021.29\u003c/span\u003e\u003cspan address=\"10.34172/ijer.2021.29\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ede Sanctis J et al (Aug. 2014) Complex prosthetic joint infections due to carbapenemase-producing Klebsiella pneumoniae: a unique challenge in the era of untreatable infections. Int J Infect Dis IJID Off Publ Int Soc Infect Dis 25:73\u0026ndash;78. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ijid.2014.01.028\u003c/span\u003e\u003cspan address=\"10.1016/j.ijid.2014.01.028\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatel KH et al (Aug. 2023) Microbiological Profile of Fracture Related Infection at a UK Major Trauma Centre. Antibiot Basel Switz 12(9):1358. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/antibiotics12091358\u003c/span\u003e\u003cspan address=\"10.3390/antibiotics12091358\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCr\u0026eacute;met L et al (2015) Pathogenic potential of Escherichia coli clinical strains from orthopedic implant infections towards human osteoblastic cells, \u003cem\u003ePathog. Dis.\u003c/em\u003e, vol. 73, no. 8, p. ftv065, Nov. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/femspd/ftv065\u003c/span\u003e\u003cspan address=\"10.1093/femspd/ftv065\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Maseno University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Orthopedic implant infections, Gram-negative bacteria, Antibiotic susceptibility, Antimicrobial resistance","lastPublishedDoi":"10.21203/rs.3.rs-7436707/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7436707/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eImplant-related infections are a major complication of orthopedic implant surgeries and represent a significant public health concern, as they contribute to prolonged morbidity, increased antibiotic use, and high treatment costs. This study aimed to identify the bacterial species involved in these infections, analyze their distribution across infection phases and determine their antimicrobial susceptibility profiles among patients receiving surgical care at Kakamega County Teaching and Referral Hospital, Kenya.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a hospital-based, descriptive cross-sectional study conducted between August 2024 and April 2025. \u0026nbsp;From a target population of approximately 600 patients orthopedic implant patients, 191 were systematically selected after obtaining informed consent. Swab samples were collected and cultured on Sheep Blood Agar (SBA), Chocolate agar and MacConkey agar supplemented with Crystal violet. Purity plating was performed to isolate pure colonies. Bacterial identification and antimicrobial susceptibility testing (AST) were conducted using the VITEK 2 system. The interpretation of AST results was done according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Descriptive statistics were used to determine the frequency of bacterial species and their antibiotic susceptibility patterns.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe most prevalent Gram-negative bacterial species isolated were \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e (29.2%),\u003cem\u003e Escherichia coli\u003c/em\u003e (17.9%), \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (16.9%), and\u003cem\u003e Citrobacter freundii \u003c/em\u003e(10.3%). Other Gram-negative bacteria, including \u003cem\u003eProteus mirabilis \u003c/em\u003e(4.1%),\u003cem\u003e Providencia stuartii, Raoultella ornithinolytica\u003c/em\u003e and \u003cem\u003eKlebsiella oxytoca, \u003c/em\u003ewere each detected in less than 2.2% of cases. \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (14.9%) and \u003cem\u003eStaphylococcus epidermidis \u003c/em\u003e(2.1%) were the only Gram-positive species isolated\u003cem\u003e.\u003c/em\u003e No bacterial growth was observed in 1.0% of the samples. The distribution of infections by phase was 47.7% in the early phase, 50.7% in the delayed phase, and 1.6% in the late phase. High resistance rates were observed to ampicillin, penicillin, vancomycin, and the cephalosporins cefazolin, cefixime, ceftriaxone, and Ceftazidime. In contrast, amikacin and piperacillin-tazobactam showed the highest sensitivity across multiple isolates.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThese findings demonstrate a marked predominance of Gram-negative bacteria as the primary causative agents of orthopedic implant infections at the study site, suggesting a potential shift from \u003cem\u003eStaphylococcus aureus,\u003c/em\u003e which is indicated in most studies as the leading pathogen. The observed resistance pattern highlights the need for routine, individualized antimicrobial susceptibility testing to guide effective, targeted antibiotic therapy in postoperative orthopedic implant infections.\u003c/p\u003e","manuscriptTitle":"Predominance of Gram-Negative Bacteria and Their Antibiotic Resistance Profiles in Orthopedic Implant Infections at a Tertiary Hospital in Kenya","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 07:45:13","doi":"10.21203/rs.3.rs-7436707/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a7f775be-ee93-4b66-8f55-3d5d1ce7b8f2","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":53638748,"name":"Infectious Diseases"}],"tags":[],"updatedAt":"2025-08-27T07:45:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-27 07:45:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7436707","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7436707","identity":"rs-7436707","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}