caa a22 4500 606158049 CHVBK 20210128100617.0 cr unu---uuuuu 210128e20151101xx s 000 0 eng 10.1007/s10096-015-2478-7 doi (NATIONALLICENCE)springer-10.1007/s10096-015-2478-7 Antimicrobial efficacy of preoperative skin antisepsis and clonal relationship to postantiseptic skin-and-wound flora in patients undergoing clean orthopedic surgery [Elektronische Daten] [G. Daeschlein, M. Napp, F. Layer, S. von Podewils, H. Haase, R. Spitzmueller, O. Assadian, R. Kasch, G. Werner, M. Jünger, P. Hinz, A. Ekkernkamp] Nosocomial surgical site infections (SSI) are still important complications in surgery. The underlying mechanisms are not fully understood. The aim of this study was to elucidate the possible role of skin flora surviving preoperative antisepsis as a possible cause of SSI. We conducted a two-phase prospective clinical trial in patients undergoing clean orthopedic surgery at a university trauma center in northern Germany. Quantitative swab samples were taken from pre- and postantiseptic skin and, additionally, from the wound base, wound margin, and the suture of 137 patients. Seventy-four patients during phase I and 63 during phase II were investigated. Microbial growth, species spectrum, and antibiotic susceptibility were analyzed. In phase two, the clonal relationship of strains was additionally analyzed. 18.0% of the swab samples were positive for bacterial growth in the wound base, 24.5% in the margin, and 27.3% in the suture. Only 65.5% of patients showed a 100% reduction of the skin flora after antisepsis. The microbial spectrum in all postantiseptic samples was dominated by coagulase-negative staphylococci (CoNS). Clonally related staphylococci were detected in ten patients [nine CoNS, one methicillin-susceptible Staphylococcus aureus (MSSA)]. Six of ten patients were suspected of having transmitted identical clones from skin flora into the wound. Ethanol-based antisepsis results in unexpected high levels of skin flora, which can be transmitted into the wound during surgery causing yet unexplained SSI. Keeping with the concept of zero tolerance, further studies are needed in order to understand the origin of this flora to allow further reduction of SSI. Springer-Verlag Berlin Heidelberg, 2015 Daeschlein G. Department of Dermatology, University Medicine, Ernst-Moritz-Arndt University Greifswald, Sauerbruchstr., 17475, Greifswald, Germany aut Napp M. Department of Trauma and Orthopedic Surgery, Clinic of Surgery, University Medicine, Ernst-Moritz-Arndt University Greifswald, Sauerbruchstr., 17475, Greifswald, Germany aut Layer F. National Reference Center for Staphylococci and Enterococci, Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany aut von Podewils S. Department of Dermatology, University Medicine, Ernst-Moritz-Arndt University Greifswald, Sauerbruchstr., 17475, Greifswald, Germany aut Haase H. Department of Dermatology, University Medicine, Ernst-Moritz-Arndt University Greifswald, Sauerbruchstr., 17475, Greifswald, Germany aut Spitzmueller R. Department of Trauma and Orthopedic Surgery, Clinic of Surgery, University Medicine, Ernst-Moritz-Arndt University Greifswald, Sauerbruchstr., 17475, Greifswald, Germany aut Assadian O. Clinical Institute of Hospital Hygiene, Medical University of Vienna, Vienna, Austria aut Kasch R. Department of Orthopaedics and Orthopaedic Surgery, University Medicine, Ernst-Moritz-Arndt University Greifswald, Sauerbruchstr., 17475, Greifswald, Germany aut Werner G. National Reference Center for Staphylococci and Enterococci, Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany aut Jünger M. Department of Dermatology, University Medicine, Ernst-Moritz-Arndt University Greifswald, Sauerbruchstr., 17475, Greifswald, Germany aut Hinz P. Department of Trauma and Orthopedic Surgery, Clinic of Surgery, University Medicine, Ernst-Moritz-Arndt University Greifswald, Sauerbruchstr., 17475, Greifswald, Germany aut Ekkernkamp A. Department of Trauma and Orthopedic Surgery, Clinic of Surgery, University Medicine, Ernst-Moritz-Arndt University Greifswald, Sauerbruchstr., 17475, Greifswald, Germany aut European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/11(2015-11-01), 2265-2273 0934-9723 34:11<2265 2015 34 10096 https://doi.org/10.1007/s10096-015-2478-7 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10096-015-2478-7 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Daeschlein G. Department of Dermatology, University Medicine, Ernst-Moritz-Arndt University Greifswald, Sauerbruchstr., 17475, Greifswald, Germany aut NATIONALLICENCE 700 1- Napp M. Department of Trauma and Orthopedic Surgery, Clinic of Surgery, University Medicine, Ernst-Moritz-Arndt University Greifswald, Sauerbruchstr., 17475, Greifswald, Germany aut NATIONALLICENCE 700 1- Layer F. National Reference Center for Staphylococci and Enterococci, Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany aut NATIONALLICENCE 700 1- von Podewils S. Department of Dermatology, University Medicine, Ernst-Moritz-Arndt University Greifswald, Sauerbruchstr., 17475, Greifswald, Germany aut NATIONALLICENCE 700 1- Haase H. Department of Dermatology, University Medicine, Ernst-Moritz-Arndt University Greifswald, Sauerbruchstr., 17475, Greifswald, Germany aut NATIONALLICENCE 700 1- Spitzmueller R. Department of Trauma and Orthopedic Surgery, Clinic of Surgery, University Medicine, Ernst-Moritz-Arndt University Greifswald, Sauerbruchstr., 17475, Greifswald, Germany aut NATIONALLICENCE 700 1- Assadian O. Clinical Institute of Hospital Hygiene, Medical University of Vienna, Vienna, Austria aut NATIONALLICENCE 700 1- Kasch R. Department of Orthopaedics and Orthopaedic Surgery, University Medicine, Ernst-Moritz-Arndt University Greifswald, Sauerbruchstr., 17475, Greifswald, Germany aut NATIONALLICENCE 700 1- Werner G. National Reference Center for Staphylococci and Enterococci, Division of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany aut NATIONALLICENCE 700 1- Jünger M. Department of Dermatology, University Medicine, Ernst-Moritz-Arndt University Greifswald, Sauerbruchstr., 17475, Greifswald, Germany aut NATIONALLICENCE 700 1- Hinz P. Department of Trauma and Orthopedic Surgery, Clinic of Surgery, University Medicine, Ernst-Moritz-Arndt University Greifswald, Sauerbruchstr., 17475, Greifswald, Germany aut NATIONALLICENCE 700 1- Ekkernkamp A. Department of Trauma and Orthopedic Surgery, Clinic of Surgery, University Medicine, Ernst-Moritz-Arndt University Greifswald, Sauerbruchstr., 17475, Greifswald, Germany aut NATIONALLICENCE 773 0- European Journal of Clinical Microbiology & Infectious Diseases Springer Berlin Heidelberg 34/11(2015-11-01), 2265-2273 0934-9723 34:11<2265 2015 34 10096