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Methicillin-resistant Staphylococcus epidermidis in infection of hip arthroplasties
P J James1, I A Butcher, E R Gardner
1Western Infirmary, Glasgow, Scotland, UK.
Abstract:
We investigated the incidence of cephalosporin-resistant bacteria in infected hip arthroplasties. Of 740 patients having hip replacement or related procedures performed over three years, 30 had positive bacteriological cultures from tissue removed at the time of surgery. In 18 of the 30 cultures Staphylococcus epidermidis was grown and 12 of these were methicillin-resistant. A prospective study of skin swabs taken from 100 consecutive patients at the time of admission for THR showed methicillin-resistant Staphylococcus epidermidis in 25. This cephalosporin-resistant organism was shown to be the commonest proven cause of infection, and its presence as a skin commensal raises important questions about current antibiotic prophylaxis for joint replacement.
Insights
Methicillin-resistant Staphylococcus epidermidis is the most common cause of hip replacement infections. This bacteria, found on skin, challenges current antibiotic prophylaxis strategies for joint replacement surgery.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Hip arthroplasty is susceptible to bacterial infections.
- Antibiotic prophylaxis is standard to prevent surgical site infections.
Purpose of the Study:
- To determine the incidence of cephalosporin-resistant bacteria in infected hip arthroplasties.
- To identify the most common bacterial cause of hip replacement infections.
Main Methods:
- Retrospective analysis of 740 hip arthroplasty patients over three years.
- Bacteriological cultures from surgical tissue and prospective skin swabs from 100 patients.
Main Results:
- 30 patients had positive cultures; Staphylococcus epidermidis was identified in 18.
- 12 of these Staphylococcus epidermidis isolates were methicillin-resistant.
- Methicillin-resistant Staphylococcus epidermidis was found in 25% of pre-operative skin swabs.
Conclusions:
- Methicillin-resistant Staphylococcus epidermidis is the most frequent pathogen causing hip arthroplasty infections.
- The high prevalence of this organism as a skin commensal necessitates re-evaluation of antibiotic prophylaxis protocols for joint replacement surgery.