title: Antibiotic susceptibility in gram-positive chronic joint arthroplasty infections: increased aminoglycoside resistance rate in patients with prior aminoglycoside-impregnated cement spacer use.
abstract: Two-stage revision using aminoglycoside-cement spacers (A-CSs) is widely used to manage chronic periprosthetic joint infection (PJI). However, aminoglycoside-resistance in gram-positive cocci (GPC) seems to be increasing. Moreover, the contribution of these A-CSs to select resistant mutants is a matter of concern. We study the antibiotic susceptibility profile of GPC after 113 chronic hip and knee PJIs. Aminoglycoside susceptibility-profiles were compared between cases where A-CSs had previously been used (n: 52), and cases of primary infection (n: 61). 32% of isolates were resistant to gentamicin and 40.6% to tobramycin. Gentamicin resistance after previous A-CS use was significantly higher (49.2% [30/61] vs. 19.3% [16/83]; P: 0.0001) as well as with tobramycin (52.7% [29/55] vs. 30.9% [21/66]; P: 0.014). A high rate of gentamicin-tobramycin resistance exists among the most common bacteria involved in chronic-PJI. The risk of selection for aminoglycoside-resistant mutants in cases of infection relapse is a concern following A-CS use.
authors.affiliation: Department of Orthopaedic Surgery, Hospital Universitario Vall d´Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain; Reconstructive Surgery and Septic Division, Hospital Universitario Vall d´Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain; Hospital Universitario Vall d´Hebron, Barcelona, Spain.
authors.forename: Pablo S
authors.initials: PS
authors.lastname: Corona
authors.affiliation: Department of Orthopaedic Surgery, Hospital Universitario Vall d´Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain; Hospital Universitario Vall d´Hebron, Barcelona, Spain.
authors.forename: Laia
authors.initials: L
authors.lastname: Espinal
authors.affiliation: Infectious Diseases Department, Hospital Universitario Vall d´Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain; Hospital Universitario Vall d´Hebron, Barcelona, Spain.
authors.forename: Dolors
authors.initials: D
authors.lastname: Rodríguez-Pardo
authors.affiliation: Infectious Diseases Department, Hospital Universitario Vall d´Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain; Hospital Universitario Vall d´Hebron, Barcelona, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Pigrau
authors.affiliation: Microbiology Department, Hospital Universitario Vall d´Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain; Hospital Universitario Vall d´Hebron, Barcelona, Spain.
authors.forename: Nieves
authors.initials: N
authors.lastname: Larrosa
authors.affiliation: Department of Orthopaedic Surgery, Hospital Universitario Vall d´Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain; Reconstructive Surgery and Septic Division, Hospital Universitario Vall d´Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain; Hospital Universitario Vall d´Hebron, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Flores
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001843:Bone Cements / Q000627:therapeutic use; D002908:Chronic Disease; D024881:Drug Resistance, Bacterial; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000601:surgery*; D012189:Retrospective Studies; D055502:Secondary Prevention; D014031:Tobramycin / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D005839:Gentamicins; D014031:Tobramycin
keywords: antibiotic loaded spacers; antibiotic resistance; gentamicin; periprosthetic joint infection; tobramycin