Development of resistant strains of Staphylococcus epidermidis on gentamicin-loaded bone cement in vivo.
We have compared the rates of infection and resistance in an animal model of an orthopaedic procedure which was contaminated with a low-dose inoculum of Staphylococcus epidermidis. We randomised 44 Sprague-Dawley rats to have bone cement implanted subcutaneously containing either gentamicin or saline (control). The wound was inoculated with a dilute solution of gentamicin-sensitive Staphylococcus epidermidis. At two weeks the cement was retrieved and microbiologically tested. A lower overall rate of infection was seen in the gentamicin-loaded cement group, but there was a significantly higher rate of gentamicin-resistant infection in this group (Fisher's exact test, p < 0.01). Antibiotic-impregnated cement has an optimum surface for colonisation and prolonged exposure to antibiotic allows mutational resistance to occur. Gentamicin-loaded cement may not be appropriate for revision surgery if it has been used already in previous surgery.
Department of Surgical Research, The Royal College of Surgeons, Beaumont Hospital, Dublin, Ireland.
B
B
Thomes
P
P
Murray
D
D
Bouchier-Hayes
D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001843:Bone Cements; D004337:Drug Carriers; D004352:Drug Resistance, Microbial; D005839:Gentamicins / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D023421:Models, Animal; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D012086:Reoperation; D013212:Staphylococcus epidermidis / Q000187:drug effects*
D000900:Anti-Bacterial Agents; D001843:Bone Cements; D004337:Drug Carriers; D005839:Gentamicins