Emerging antibiotic-resistant bacteria. Their treatment in total joint arthroplasty

Successful treatment of an infected total joint arthroplasty can be achieved in approximately 90% of cases. This outcome may be jeopardized by the emergence of antibiotic resistance in bacteria common to these infections. Staphylococci are the most frequently isolated bacteria in total joint infections, and the prevalence of antibiotic resistance in these organisms among all nosocomial and community-acquired infections has been increasing. As many as 46.7% of Staphylococcus aureus strains and 85.7% of coagulase-negative staphylococci strains are methicillin-resistant. Enterococci also are commonly isolated from infected total joint arthroplasties. The prevalence of vancomycin-resistant enterococci among all enterococci strains is estimated at 23%. As the prevalence of these resistant bacteria continues to increase among all infections, it is anticipated that they will be encountered more regularly in total joint infections. Knowledge of the mechanisms of resistance of these bacteria and currently available and newly developed antimicrobials is key to preventing the expansion of antimicrobial resistance and ensuring the future successful treatment of total joint infections.