High Rate of Aminoglycoside Resistance among Staphylococci Causing Prosthetic Joint Infection

Abstract

Gentamicin and tobramycin are two aminoglycosides commonly impregnated into polymethylmethacrylate for treatment and prevention of prosthetic joint infection. Susceptibilities of staphylococci to aminoglycosides are not reported routinely in the United States. The gentamicin and tobramycin minimum inhibitory value of 93 staphylococci from patients with PJI were determined. Forty-one and 66% of the isolates were resistant to gentamicin and tobramycin, respectively. Methicillin-resistant Staphylococcus aureus isolates were more likely to be resistant to gentamicin or tobramycin than were their methicillin susceptible counterparts. The findings suggest that consideration should be given to the further study of agents other than aminoglycosides for incorporation into polymethylmethacrylate for the treatment and prevention of prosthetic joint infection.

Aminoglycoside-resistant staphylococci in Greece: prevalence and resistance mechanisms

“…For the treatment of skeletal infections, gentamicin-loaded bone cement beads, tobramycin impregnated beads and bone graft substitutes offer high concentrations of antibiotics at the site of infection [9]. However, local usage of aminoglycosides could rapidly induce antibiotic resistance among staphylococci with subsequent reduced effect on prophylaxis [10]. Since CoNS and S. aureus are the leading cause of device-related infections, continued surveillance concerning the resistance of staphylococci to aminoglycosides is required.…”

Industrially Prefabricated Cement Spacers: Do Vancomycin- and Gentamicin-impregnated Spacers Offer Any Advantage?

“…Because aminoglycosides meet all the requirements, they were considered the preferred antibiotics for this treatment approach [6,10,25,27,28,41]. Staphylococcus species are the principal bacterial family related to TKA or THA infections [13,23,29], therefore a possible increase in aminoglycoside resistance in staphylococci causing an infection is a concern, and potentially might impact the utility of classic aminoglycoside-impregnated cement spacers [3,5,13,29,35]. This suggests that the use of other antibiotics or combinations of antibiotics in bone cement could be more effective for elimination of infection.…”

Cytotoxicity of a new antimicrobial coating for surgical screws: an in vivo study

“…(1,3,17) As antibiotic cement cannot be used in all joint replacements, there is increased interest in the development of other materials that inhibit bacterial reproduction on implants. (4,18) Such materials include silver and silver compounds, selenium and antimicrobial peptides. (5,(17)(18)(19)(20) Silver-or selenium-coated implants are effective (20,21) but expensive; furthermore, the use …”

“…gentamicin and tobramycin) remains to be evaluated, silver coatings have been shown to be both costly and cytotoxic. (4,17,19,20) Silver (ions or nanoparticles), which kills bacteria by attacking the thiol groups of the extracellular domains of membrane proteins, has been shown to be toxic to eukaryotic cells in vitro. The nanoscale dimension is a risk factor for dosedependent cell death, as no physical barrier prevents nanoparticle uptake by cells.…”

“…Although antibiotic-impregnated implants have been reported to successfully prevent infection in orthopaedic patients, there are concerns that the use of such implants may lead to increased bacterial antibiotic resistance. (3)(4)(5) Implant infection commences when bacteria adhere to the implant and reproduce to form a biofilm (6) that will, in turn, promote antibiotic resistance; this challenges the immune system and triggers the need for higher doses of antibiotics. (7) Sessile bacteria in biofilms are difficult to identify and treat.…”