• Richard J Holleyman, David J Deehan, Lucy Walker, Andre Charlett, Julie Samuel, Shirley Mark D F MDF Biological, Clinical, and Environmental Systems Modelling Group, School of Biology, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK., and Paul N Baker.
• Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK. r.holleyman@googlemail.com.
• Arch Orthop Trauma Surg. 2019 Sep 1; 139 (9): 1209-1215.

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.

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