Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
Health Education North East, Newcastle upon Tyne, NE15 8NY, UK.
Arch Orthop Trauma Surg. 2019 Sep;139(9):1209-1215. doi: 10.1007/s00402-019-03155-1. Epub 2019 Mar 15.
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.
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.
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.
Clinicians must anticipate the possibility of antibiotic resistance to ALBC utilised at primary surgery.
本研究旨在：(1) 报告多种抗生素对单纯葡萄球菌感染的耐药率；(2) 研究初次髋关节和膝关节翻修术时，在初次手术中使用抗生素骨水泥（antibiotic-loaded bone cement，ALBC）对因感染行初次翻修的患者的耐药模式的影响。
对英格兰和威尔士国家关节登记数据库的数据与英国公共卫生署的微生物学数据进行了关联，以确定 2003 年 4 月至 2014 年 1 月期间连续进行的 258 例髋关节和膝关节初次置换术，这些手术因葡萄球菌性深部假体周围感染而进行了翻修。采用多变量二项逻辑回归分析来研究微生物对一系列抗菌药物耐药的预测因素。
在调整了患者和手术因素后，多变量分析显示初次手术中使用庆大霉素骨水泥与葡萄球菌庆大霉素耐药（比值比 8.341，95%置信区间 2.297-30.292，p=0.001）和耐甲氧西林（比值比 3.870，95%置信区间 1.319-11.359，p=0.014）的风险显著增加有关。
临床医生必须预料到初次手术中使用的 ALBC 产生抗生素耐药的可能性。
