Abstract
IntroductionThis study aimed to (1) report the rates of resistance against a variety of antibiotics for pure Staphylococcal infections, and (2) examine the impact of ALBC use at primary surgery has on resistance patterns for patients undergoing first-time revision of primary hip and knee arthroplasty for indication of infection.Materials and methodsData from the National Joint Registry database for England and Wales were linked to microbiology data held by Public Health England to identify a consecutive series of 258 primary hip and knee arthroplasties performed between April 2003 and January 2014 that went on to have a revision for Staphylococcal deep periprosthetic infection. Multivariate binary logistic regression was used to study predictors of microorganism resistance to a range of antimicrobials.ResultsAfter adjusting for patient and surgical factors, multivariate analysis showed the use of gentamicin-loaded bone cement at the primary surgery was associated with a significant increase in the risk of Staphylococcal gentamicin resistance (odds ratio 8.341, 95% CI 2.297–30.292, p = 0.001) and methicillin resistance (odds ratio 3.870, 95% CI 1.319–11.359, p = 0.014) at revision for infection.ConclusionsClinicians must anticipate the possibility of antibiotic resistance to ALBC utilised at primary surgery.
Highlights
This study aimed to (1) report the rates of resistance against a variety of antibiotics for pure Staphylococcal infections, and (2) examine the impact of antibiotic-loaded bone cement (ALBC) use at primary surgery has on resistance patterns for patients undergoing first-time revision of primary hip and knee arthroplasty for indication of infection
Deep periprosthetic infection (PJI) following primary hip and knee arthroplasty is a catastrophic complication in terms of patient outcome and cost to the health service
Implicated microorganism(s) are important determinants of clinical outcome and previous work by our group has described the epidemiology in England and Wales by linking data held by the national joint registry (NJR) to national microbiology data [11, 12]
Summary
This study aimed to (1) report the rates of resistance against a variety of antibiotics for pure Staphylococcal infections, and (2) examine the impact of ALBC use at primary surgery has on resistance patterns for patients undergoing first-time revision of primary hip and knee arthroplasty for indication of infection. Using data from the National Joint Registry for England and Wales and Public Health England, this study aimed to: (1) report the rates of resistance against a variety of antibiotics for pure Staphylococcal infections, and (2) examine the impact of ALBC use on resistance patterns for Archives of Orthopaedic and Trauma Surgery (2019) 139:1209–1215 patients undergoing first-time revision of primary hip and knee replacement for indication of infection
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