Bacteria antibiotic resistance: New challenges and opportunities for implant‐associated orthopedic infections

• Published in: Journal of orthopaedic research Vol. 36; no. 1; pp. 22 - 32
• Main Authors: Li, Bingyun, Webster, Thomas J.
• Format: Journal Article
• Language: English
• Published: United States 01-01-2018
• Subjects: antibiotic alternative; antibiotic resistance; Drug Resistance, Bacterial; Humans; infection; Methicillin-Resistant Staphylococcus aureus; multidrug resistance; orthopedic implant; Orthopedic Procedures - adverse effects; Prosthesis-Related Infections - drug therapy; S. aureus; multidrug resistance; infection; orthopedic implant; S. aureus; antibiotic alternative; antibiotic resistance
• ISSN: 0736-0266; 1554-527X
• DOI: 10.1002/jor.23656

ABSTRACT
There has been a dramatic increase in the emergence of antibiotic‐resistant bacterial strains, which has made antibiotic choices for infection control increasingly limited and more expensive. In the U.S. alone, antibiotic‐resistant bacteria cause at least 2 million infections and 23,000 deaths a year resulting in a $55–70 billion per year economic impact. Antibiotics are critical to the success of surgical procedures including orthopedic prosthetic surgeries, and antibiotic resistance is occurring in nearly all bacteria that infect people, including the most common bacteria that cause orthopedic infections, such as Staphylococcus aureus (S. aureus). Most clinical cases of orthopedic surgeries have shown that patients infected with antibiotic‐resistant bacteria, such as methicillin‐resistant S. aureus (MRSA), are associated with increased morbidity and mortality. This paper reviews the severity of antibiotic resistance at the global scale, the consequences of antibiotic resistance, and the pathways bacteria used to develop antibiotic resistance. It highlights the opportunities and challenges in limiting antibiotic resistance through approaches like the development of novel, non‐drug approaches to reduce bacteria functions related to orthopedic implant‐associated infections. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:22–32, 2018.
Most of the known urgent, serious, and concerning antibiotic resistant microorganisms have been increasingly reported in orthopedic implant‐associated infections. Different antibiotic‐resistant profiles have been identified between older and younger patients, and between patients with and without orthopedic implants. Overall, orthopedic infections caused by antibiotic‐resistant microorganisms have a less than optimal clinical outcome compared to those caused by antibiotic susceptible microorganisms. Various opportunities and challenges have emerged in limiting antibiotic resistance.