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

Lookup NU author(s): Dr Richard Holleyman, Professor David Deehan, Dr Mark ShirleyORCiD, Paul Baker



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


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.

Publication metadata

Author(s): Holleyman RJ, Deehan DJ, Walker L, Charlett A, Samuel J, Shirley MDF, Baker PN

Publication type: Article

Publication status: Published

Journal: Archives of Orthopaedic and Trauma Surgery

Year: 2019

Volume: 139

Pages: 1209–1215

Print publication date: 01/09/2019

Online publication date: 15/03/2019

Acceptance date: 15/03/2019

Date deposited: 18/03/2019

ISSN (print): 0936-8051

ISSN (electronic): 1434-3916

Publisher: Springer Berlin Heidelberg


DOI: 10.1007/s00402-019-03155-1


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