title: Microbiology of infected arthroplasty: implications for empiric peri-operative antibiotics.
abstract: OBJECTIVE
  To classify the spectrum and antibiotic susceptibility of bacteria isolated from infected hip and knee arthroplasty specimens, and to recommend appropriate empiric peri-operative antibiotics.
  
  
  METHODS
  From January 1999 to August 2006, specimens from revision hip and knee arthroplasties (with or without suspected infection) were routinely collected for identifying possible organisms and their susceptibility patterns. During the period, 147 patients had positive specimens yielding 248 micro-organisms (from 195 tissue specimens, 43 fluid specimens, and 10 swabs). 140 isolates were from hips and 108 from knees.
  
  
  RESULTS
  Most isolates were Gram-positive; their distribution was similar in hip and knee specimens. Of the 248 micro-organisms isolated, Staphylococcus was the most common genus encountered (131, 53%), followed by Gram-negative isolates (24%). 88% of Gram-negative organisms were detected within 48 hours of inoculation and 94% of Gram-positive organisms within 96 hours. Overall, 46% of isolates were susceptible to cephalothin. Only 35% of coagulase-negative staphylococci were sensitive to cephalothin. No Gram-positive vancomycin resistance was encountered.
  
  
  CONCLUSIONS
  Empiric prophylactic antibiotics for revision hip and knee arthroplasties should include vancomycin to cover Gram-positive organisms and gentamicin for most Gram-negative bacteria.
authors.affiliation: The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Sharma
authors.forename: J
authors.initials: J
authors.lastname: Douglas
authors.forename: C
authors.initials: C
authors.lastname: Coulter
authors.forename: P
authors.initials: P
authors.lastname: Weinrauch
authors.forename: R
authors.initials: R
authors.lastname: Crawford
mesh_terms: D019072:Antibiotic Prophylaxis; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*