Staphylococcal resistance profiles in deep infection following primary hip and knee arthroplasty: a study using the NJR dataset

Abstract

Introduction 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. Materials and methods Data 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. Results After 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. Conclusions Clinicians must anticipate the possibility of antibiotic resistance to ALBC utilised at primary surgery.

Adjuvant antibiotic‐loaded bone cement: Concerns with current use and research to make it work

“…Hansen et al 39 did not find a change in antibiotic resistance patterns after the introduction of routine ALBC in primary TKA. Data from the National Joint Registry, however, have shown that the use of gentamicin‐loaded bone cement in primary TKA and THA increases the risk of gentamicin resistance and methicillin resistance at the time of revision for subsequent PJI 40 . Further studies are warranted to assess the consequences of antibiotic resistance in the setting of ALBC use in primary joint replacement.…”

Antibiotics and cement: what I need to know?

“…It was therefore advocated to be suspicious of a possible gentamicin resistance in septic revision situations and better combine 2 antibiotics in the spacer/revision cement. 21,22 Of most clinical importance was the recent finding that bacteria found in PJI -even if resistant to gentamicin -did not show cross-resistancies to other antibiotics commonly used for antibiotic treatment. 23 Resistance patterns in Nordic countries…”

Nano-Modified Titanium Implant Materials: A Way Toward Improved Antibacterial Properties

“…The occurrence of infection not only leads to the failure of the implant and the surgery but also increases the patients’ recovery period and makes an economic burden on both patients and the medical system. The use of antibiotics is a common and effective way to control this issue, but it also has some disadvantages ( Klein et al, 2016 ; Holleyman et al, 2019 ). Bacterial infection on the surface of the implanted material may eventually form a biofilm and reduce or completely inhibit the beneficial effects of the bactericidal drugs.…”