Choice of Antibiotics for the Treatment of Orthopedic Infection Caused by Gram-Positive Pathogens, Based on a 12-Year Follow-Up. Part 1: Penicillins, Cephalosporins, Glycopeptides, Oxazolidinones, Fusidic Acid, Rifampicin

Background. Antibacterial agents are used in orthopedic practice to prevent surgical site infections, as well as for empirical and etiotropic antibacterial therapy. Each of the groups of antibacterial agents has specific indications for use and limitations that determine their role in empirical and etiotropic treatment regimens for musculoskeletal infections. The aim of the study — to substantiate the choice of a drug for empirical antibacterial therapy based on the analysis of antimicrobial resistance dynamics in leading Gram-positive bacteria isolated from patients with orthopedic infection from 2011 to 2022. Methods. We performed a retrospective study of data on the antimicrobial susceptibility in leading Gram-positive bacteria isolated from patients who were treated at the purulent osteology department from 01.01.2022 to 31.12.2022. Based on the data obtained, we investigated the dynamics and determined the prognosis of resistance in leading Gram-positive pathogens. This article analyzes 5 groups of antibiotics active against Gram(+) microorganisms: ß-lactams, glycopeptides, oxazolidinones, rifampicin, fusidic acid. Results. The cumulative proportion of Gram(+) bacteria sensitive to ß-lactams accounted for 60.8%. During the study time period, vancomycin was active against 99.65% of Gram(+) bacteria and only 2 linezolid-resistant E. faecium strains were isolated. The average proportion of fusidic acid-resistant MRSA strains over the 12-year follow-up period was 0.7%; MSSE — 14.1%; MRSE — 10%; MSSA — 0%. The proportion of rifampicin-resistant MSSA and MSSE strains did not exceed 3% throughout the follow-up. MRSA and MRSE resistance to rifampicin averaged 25 and 16.3%, respectively. Conclusions. In this article, we have considered groups of antibiotics that are predominantly active against Gram(+) microorganisms. The study showed that ß-lactam antibiotics, despite their widespread use in all fields of medicine, remain active against a significant proportion of Gram(+) bacteria. The maximum activity against the studied pathogens is demonstrated by vancomycin and linezolid. The obtained results could help to improve the empirical antibacterial therapy, taking into account resistance and availability of the drugs. The second part of the study will be devoted to broad-spectrum antibiotics.