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Changes in Antibiotic Susceptibility of Staphylococcus aureus Between the Stages of 2-Stage Revision Arthroplasty

Jaiben George1, Jared M Newman1, Alison K Klika1

  • 1Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.

The Journal of Arthroplasty
|March 6, 2018
PubMed
Abstract

Insights

Antibiotic resistance in Staphylococcus aureus can emerge during 2-stage revision arthroplasty. Vancomycin minimum inhibitory concentrations (MICs) increased in about one-third of patients, raising concerns for periprosthetic joint infection (PJI) treatment.

Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Microbiology

Background:

  • Staphylococcus aureus is a primary cause of periprosthetic joint infection (PJI).
  • Antibiotic resistance is a growing concern in managing PJI.
  • Two-stage revision arthroplasty involves antibiotic cement spacers, but resistance may emerge between stages.

Purpose of the Study:

  • To investigate changes in antibiotic susceptibility of Staphylococcus aureus between the first and second stages of 2-stage revision arthroplasty for PJI.
  • To assess the emergence of antibiotic resistance in Staphylococcus aureus during the interval of 2-stage revision procedures.

Main Methods:

  • Retrospective review of 1614 two-stage revision hip/knee arthroplasties for PJI (2000-2015).
  • Identified cases with Staphylococcus aureus (methicillin-susceptible and/or resistant) during both stages.
  • Compared minimum inhibitory concentrations (MICs) of antibiotics, particularly vancomycin, between the first and second surgical stages.

Main Results:

  • Staphylococcus aureus was isolated in 402 cases during the first stage and persisted in 30 cases for the second stage.
  • Nine (30%) of these cases showed an increase in vancomycin MIC.
  • All nine cases with increased vancomycin MIC had vancomycin incorporated into the antibiotic cement spacer.

Conclusions:

  • Increased vancomycin MICs were observed in approximately one-third of Staphylococcus aureus infections between stages of 2-stage revision.
  • The use of vancomycin in cement spacers may be associated with the emergence of reduced susceptibility.
  • This preliminary study highlights the potential for antibiotic resistance to develop during the interval of 2-stage revision arthroplasty, impacting PJI management.
Keywords:
2-stage revisionantimicrobial resistanceminimum inhibitory concentrationperiprosthetic joint infectionpersistent infection

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