Causative organisms in revision total hip & knee arthroplasty for infection: Increasing multi-antibiotic resistance in coagulase-negative Staphylococcus and the implications for antibiotic prophylaxis
Causative organisms in revision total hip & knee arthroplasty for infection: Increasing multi-antibiotic resistance in coagulase-negative Staphylococcus and the implications for antibiotic prophylaxis
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DOI：
10.1016/j.surge.2014.04.002
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发表时间：
2015-10-01
影响因子：
2.5
通讯作者：
Clift, B. A.
中科院分区：
文献类型：
--
作者：
Malhas, A. M.;Lawton, R.;Clift, B. A.
背景与目的：有报道称术后凝固酶阴性葡萄球菌（CNS）感染的耐药性增加。我们呈现我们改变抵抗模式的经验。方法：我们检查了2001年至2010年髋关节和膝关节翻修的微生物学结果，并比较了从区域泛专业来源培养的所有金黄色葡萄球菌（SA）和CNS的耐药性，以研究抗生素耐药性的模式。主要发现：67例患者进行了72次修正。最常见的微生物是SA（36%）和CNS（35%）。CNS对甲氧西林的耐药率为72%，SA为20%；CNS对庆大霉素的耐药率为40%，SA为4%。在所有区域（背景泛专业）培养中，SA对甲氧西林的耐药性从2006年的32%下降到2006年的16%，而庆大霉素的耐药性没有变化，为3%。同期，CNS对甲氧西林和庆大霉素的耐药性分别从63%上升到70%和32%-47%。结论：中枢神经系统对甲氧西林和庆大霉素的耐药性均高于SA，且呈增加趋势。来自感染TKRs/ thr的至少32%的CNS和4%的SA对我们目前的预防方案具有耐药性。这些不断变化的耐药模式可能对未来的抗生素预防制度产生影响。(C) 2014年爱丁堡皇家外科学院（苏格兰慈善机构编号SC005317）和爱尔兰皇家外科学院。Elsevier Ltd.出版。版权所有。
Background and purpose: Increasing resistance among post-operative Coagulase-negative Staphylococci (CNS) infections have been reported. We present our experience changing resistance patterns.Methods: We examined microbiological results from hip and knee revisions from 2001 to 2010 and compared resistance to all Staphylococcus aureus (SA) and CNS cultured from regional pan-speciality sources, in order to examine the patterns of antibiotic resistance.Main findings: 72 revisions in 67 patients were included. The most common organisms were SA (36%) and CNS (35%). Resistance to methicillin was 72% for CNS versus 20% for SA and resistance to gentamicin was 40% for CNS versus 4% for SA. Among all regional (background pan-speciality) cultures SA resistance to methicillin fell from 32% to 16% from 2006 to 10 with no change in gentamicin resistance at 3%. During the same period resistance of CNS to methicillin and gentamicin increased from 63% to 70% and 32%-47% respectively.Conclusions: Resistance of CNS to both methicillin and gentamicin is higher than with SA and appears to be increasing. At least 32% of CNS and 4% of SA from infected TKRs/THRs were resistant to our current prophylaxis regime. These changing patterns of resistance may have implications for future antibiotic prophylaxis regimes. (C) 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.