High Frequency of Polymicrobial Infections After Surgical Resection of Malignant Bone and Soft Tissue Tumors: A Retrospective Cohort Study.
BACKGROUND
Surgical resection of a malignant bone tumor (BT) or soft tissue tumor (STT), with or without prosthetic replacement, carries a high risk of developing postoperative infections. There is limited knowledge on the bacteriological spectrum of these postsurgical infections that necessitate empirical antibiotic therapy. The aim of this study was to analyze the incidence and microbiological features of site infections following BT or STT resection.


METHODS
In this retrospective mono-center study, we analyzed the surgical and bacteriological data of all consecutive patients who developed an infection after surgical resection of a BT or STT between January 2010 and April 2014.


RESULTS
Seventy-two consecutive patients who developed an infection on the site of surgical treatment for a BT (n = 42) or SST (n = 30) were included. Polymicrobism was frequently observed, more often associated with STTs (93%) than BTs (71%; P = 0.03). Gram-negative bacteria were more frequently isolated in STTs (55%) than in BTs (26%; P = 0.01) and non-prosthesis-associated infections (54%) than prosthesis-associated infections (29%; P = 0.04), whereas staphylococci were more frequently found in BTs (76%) than in STTs (52%; P = 0.03). Overall, we found gram negatives in 82% of early acute infections, 11% of chronic infections and 7% of late acute infections (P < 0.01).


CONCLUSIONS
Postoperative infections in patients after surgical resection of BTs or STTs were often polymicrobial, especially following STTs. Causative bacteria were often gram negatives in STTs and non-prosthesis-associated infections, whereas staphylococci were predominant in BTs. Based on these findings, we recommend antibiotic coverage of both gram-positive and -negative bacteria with a combination of broad-spectrum antibiotics in STTs and antistaphylococcal antibiotics as first-line therapy in infections following BT surgery.
Infectious and Tropical Medicine, Internal Medicine Department, Cochin Hospital APHP, Paris, France.|Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands.
Laura M
LM
Vos
Bacteriology Department, Cochin Hospital APHP, Paris, France.|Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Philippe C
PC
Morand
Université Paris Descartes, Sorbonne Paris Cité, Paris, France.|Orthopedic Surgery Department, Cochin Hospital APHP, Paris, France.
David
D
Biau
Department of Anesthesiology, Cochin Hospital APHP, Paris, France.
Denis
D
Archambeau
Department of Anesthesiology, Cochin Hospital APHP, Paris, France.
Luc-Jean
LJ
Eyrolle
Bacteriology Department, Cochin Hospital APHP, Paris, France.|Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Julien
J
Loubinoux
Department of Public Health, Cochin Hospital APHP, Paris, France.
Valerie
V
Perut
Orthopedic Surgery Department, Cochin Hospital APHP, Paris, France.
Philippe
P
Leclerc
Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands. J.E.Arends@umcutrecht.nl.
Joop E
JE
Arends
Université Paris Descartes, Sorbonne Paris Cité, Paris, France. Philippe.anract@aphp.fr.|Orthopedic Department, Cochin Hospital APHP, Paris Descartes University, Paris, France. Philippe.anract@aphp.fr.
Philippe
P
Anract
Infectious and Tropical Medicine, Internal Medicine Department, Cochin Hospital APHP, Paris, France. dominique.salmon@cch.aphp.fr.|Université Paris Descartes, Sorbonne Paris Cité, Paris, France. dominique.salmon@cch.aphp.fr.
Dominique
D
Salmon
Bone tumor; Infection postsurgical resection; Microbiology; Soft tissue tumor