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Common bacteria shows resistance to prophylactic THA antibiotic

Staphylococci represented 75% of organisms isolated from intraoperative gloves, and nearly half showed resistance to cefuroxime.

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Nearly half of the infectious organisms most likely to contaminate wounds during total hip arthroplasty proved resistant to the antibiotic cefuroxime, researchers in the United Kingdom found.

“[We] believe it is now appropriate to review the role of cefuroxime in prophylaxis and consider further work in order to identify the best prophylactic agent,” the authors said in the study, published in the British edition of The Journal of Bone & Joint Surgery.

During 50 total hip arthroplasties (THA), Mohammed Al-Maiyah, MD, and colleagues at James Cook University Hospital in Middlesbrough, England, collected impressions from both gloved hands of the principal surgeon, first assistant and scrub nurse. All impressions were made on sterile culture media containing blood agar immediately before gloves were changed, which occurred after draping and every 20 minutes throughout surgery. Gloves were also changed before cementing and anytime a glove had a visible puncture, according to the study.

The hospital’s microbiology department incubated all culture plates at 37ºC. After 48 hours, the researchers used Gram stain and other basic tests to identify any contaminating organisms, which were then tested for antibiotic resistance, according to the study.

Overall, the researchers collected impressions from 627 pairs of gloves. Of these, 57 (9%) contained a total of 106 bacterial isolates, primarily coagulase-negative staphylococcus (73 isolates, 68.9%). Other bacterial isolates included the following:

1. Micrococcus; 13 isolates (12.3%);
2. Diphtheroids; 10 isolates (9.4%);
3. Staph. aureus; 7 isolates (6.6%);
4. Pseudomonas; 2 isolates (1.9%); and
5. E. coli; 1 isolate (0.9%).

Among coagulase-negative staphylococcus isolates, only 38 (52.1%) proved sensitive to flucloxacillin, a recognized indicator of sensitivity to cefuroxime, the authors said. However, 89.4% of these isolates proved sensitive to fusidic acid and 95.9% to gentamicin, they noted.

Of the Staph. aureus isolates, 71.4% proved sensitive to flucloxacillin and 85.7% to both fusidic acid and gentamicin. Among Micrococcus isolates, 69.2% proved sensitive to flucloxacillin. However, 100% were sensitive to fusidic acid and gentamicin. Additionally, 80% of Diphtheroid isolates proved sensitive to cefuroxime and fusidic acid, and 100% to gentamicin, according to the study.

All 103 isolates of Gram-positive organisms proved sensitive to linezolid, the authors noted.

“Our findings question whether cefuroxime is the most appropriate agent for antibiotic prophylaxis since staphylococci represented 75% of contaminating isolates, nearly half of which were resistant to it,” the authors said in the study.

“However, since 95% of our isolates were sensitive to gentamicin, it seems appropriate to continue the use of this agent in the bone cement used in THA,” they said.

For more information:

• Al-Maiyah, Hill D, Bajwa A, et al. Bacterial contaminants and antibiotic prophylaxis in total hip arthroplasty. J Bone Joint Surg Br. 2005;87-B:1256-1258.