title: Analysis of causative microorganism in 248 primary hip arthroplasties revised for infection: a study using the NJR dataset.
abstract: BACKGROUND
  This study aimed to describe the epidemiology of the causative organism in a series of primary hip arthroplasties revised for a diagnosis of periprosthetic joint infection (PJI) in England and Wales.
  
  
  METHODS
  Patient data from the National Joint Registry (NJR) was linked to microbiology data held by Public Health England (PHE) which identified a series of 248 primary hip arthroplasties revised for PJI between 2003 and 2014. Definitive cultures, isolated at time of revision surgery, were available for all cases. Total hip arthroplasty (n = 239, 96%) and hip resurfacing (n = 5, 2%) were the most commonly performed primary procedures. A two-stage revision was the most common operative management (n = 174, 70%).
  
  
  RESULTS
  202 (81%) cases were infected with a single genus microorganism and the most commonly implicated genus was Staphylococcus species (70% of all single genus infections). Staphylococcus species were also the most commonly identified microorganism in mixed genus infections (74% of patient's cultures). There was a significant difference in microorganism distribution when comparing uncemented vs cement implant fixation, with a higher incidence of Gram-negative infection observed in the uncemented group (p = 0.048, Chi-square).
  
  
  CONCLUSIONS
  Both prophylactic and therapeutic antibiotic regimes should be focused on targeting Staphylococci.
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne - UK.|Health Education North East, Newcastle upon Tyne - UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Holleyman
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne - UK.|Department of Trauma and Orthopaedics, James Cook University Hospital, Middlesbrough - UK.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Baker
authors.affiliation: Centre for Infectious Disease Surveillance and Control, Public Health England, London - UK.
authors.forename: Andre
authors.initials: A
authors.lastname: Charlett
authors.affiliation: Newcastle Public Health Laboratory, Public Health England, Freeman Hospital, Newcastle upon Tyne - UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Gould
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne - UK.|Department of Trauma and Orthopaedics, Freeman Hospital, Newcastle upon Tyne - UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Deehan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004739:England; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000382:microbiology / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000382:microbiology* / Q000601:surgery; D012086:Reoperation; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D016896:Treatment Outcome; D014852:Wales; D055815:Young Adult