title: Bacterial colonization and resistance patterns in 133 patients undergoing a primary hip- or knee replacement in Southern Sweden.
abstract: OBJECTIVE
  Prosthetic joint infections can be caused by bacteria derived from the patient's skin. The aim of the study was: (1) to determine which bacteria colonize the nose and groin in patients planned for primary hip or knee arthroplasty, (2) to determine the antimicrobial resistance patterns, and (3) to monitor changes in bacterial colonization and resistance patterns connected to surgery.
  
  
  METHODS
  2 weeks before scheduled primary hip or knee arthroplasty, culture samples were taken from the anterior nares and from the groin of 133 consecutive patients. At surgery, cloxacillin was given prophylactically and cement with gentamicin was used. 2 weeks after surgery, another set of samples were taken from 120 of these patients. Bacterial findings and resistance patterns were analyzed.
  
  
  RESULTS
  Preoperatively, 95% of the patients had coagulase-negative staphylococci (CNS) in the groin and 77% in the nose. The proportion of patients with a methicillin-resistant CNS in the groin increased from 20% preoperatively to 50% postoperatively (p < 0.001), and the proportion of patients with a gentamicin-resistant CNS in the groin increased from 5% to 45% (p < 0.001). 28% of the patients had Staphylococcus aureus in the nose preoperatively, and 7% in the groin. Methicillin-resistant Staphylococcus aureus (MRSA) was found in the nose of 1 patient.
  
  
  CONCLUSIONS
  In southern Sweden, beta-lactams were effective against 99% of the Staphylococcus aureus strains and 80% of the CNS strains colonizing the patients undergoing primary hip or knee arthroplasty. Gentamicin protects against most CNS strains in cemented primary joint replacements.
authors: Department of Orthopedics, Clinical Sciences, Lund University, Lund, Sweden. anna.stefansdottir@med.lu.se
authors: Anna
authors: A
authors: Stefánsdóttir
authors: Asa
authors: A
authors: Johansson
authors: Lars
authors: L
authors: Lidgren
authors: Philippe
authors: P
authors: Wagner
authors: Annette
authors: A
authors: W-Dahl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000706:statistics & numerical data; D003023:Cloxacillin / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006119:Groin / Q000382:microbiology; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D009296:Nasal Cavity / Q000382:microbiology; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology* / Q000517:prevention & control; D013211:Staphylococcus aureus; D013548:Sweden / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D003023:Cloxacillin