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

Richard J. Holleyman; David J. Deehan; Lucy Walker; Andre Charlett; Julie Samuel; Mark D.F. Shirley; Paul N. Baker

doi:10.1007/s00402-019-03155-1

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

Richard J. Holleyman^*
, David J. Deehan
, Lucy Walker
, Andre Charlett
, Julie Samuel
, Mark D.F. Shirley
, Paul N. Baker

^*Corresponding author for this work

Statistics Unit

Research output: Contribution to journal › Article › peer-review

23 Citations (Scopus)

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.

Original language	English
Pages (from-to)	1209-1215
Number of pages	7
Journal	Archives of Orthopaedic and Trauma Surgery
Volume	139
Issue number	9
DOIs	https://doi.org/10.1007/s00402-019-03155-1
Publication status	Published - 1 Sept 2019

Bibliographical note

Funding Information:
We thank the patients and staff of all the hospitals in England, Wales and Northern Ireland who have contributed data to the National Joint Registry. We are grateful to the Healthcare Quality Improvement Partnership (HQIP), the NJR Research Sub-committee, staff at the NJR Centre and Public Health England (PHE) for facilitating this work. The authors have conformed to the NJR?s standard protocol for data access and publication. The views expressed represent those of the authors and do not necessarily reflect those of the National Joint Registry Steering Committee or the Health Quality Improvement Partnership (HQIP) who do not vouch for how the information is presented.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Arthroplasty
Infection
Resistance
Revision
Sensitivity
Staphylococcus

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10.1007/s00402-019-03155-1

Cite this

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title = "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.",

keywords = "Arthroplasty, Infection, Resistance, Revision, Sensitivity, Staphylococcus",

author = "Holleyman, \{Richard J.\} and Deehan, \{David J.\} and Lucy Walker and Andre Charlett and Julie Samuel and Shirley, \{Mark D.F.\} and Baker, \{Paul N.\}",

note = "Funding Information: We thank the patients and staff of all the hospitals in England, Wales and Northern Ireland who have contributed data to the National Joint Registry. We are grateful to the Healthcare Quality Improvement Partnership (HQIP), the NJR Research Sub-committee, staff at the NJR Centre and Public Health England (PHE) for facilitating this work. The authors have conformed to the NJR?s standard protocol for data access and publication. The views expressed represent those of the authors and do not necessarily reflect those of the National Joint Registry Steering Committee or the Health Quality Improvement Partnership (HQIP) who do not vouch for how the information is presented.",

year = "2019",

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doi = "10.1007/s00402-019-03155-1",

language = "English",

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T1 - Staphylococcal resistance profiles in deep infection following primary hip and knee arthroplasty

T2 - a study using the NJR dataset

AU - Holleyman, Richard J.

AU - Deehan, David J.

AU - Walker, Lucy

AU - Charlett, Andre

AU - Samuel, Julie

AU - Shirley, Mark D.F.

AU - Baker, Paul N.

N1 - Funding Information: We thank the patients and staff of all the hospitals in England, Wales and Northern Ireland who have contributed data to the National Joint Registry. We are grateful to the Healthcare Quality Improvement Partnership (HQIP), the NJR Research Sub-committee, staff at the NJR Centre and Public Health England (PHE) for facilitating this work. The authors have conformed to the NJR?s standard protocol for data access and publication. The views expressed represent those of the authors and do not necessarily reflect those of the National Joint Registry Steering Committee or the Health Quality Improvement Partnership (HQIP) who do not vouch for how the information is presented.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - 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.

AB - 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.

KW - Arthroplasty

KW - Infection

KW - Resistance

KW - Revision

KW - Sensitivity

KW - Staphylococcus

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C2 - 30877427

AN - SCOPUS:85062965038

SN - 0936-8051

VL - 139

SP - 1209

EP - 1215

JO - Archives of Orthopaedic and Trauma Surgery

JF - Archives of Orthopaedic and Trauma Surgery

IS - 9

ER -

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

Abstract

Bibliographical note

UN SDGs

Keywords

Access to Document

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