Guidelines for Complications of Cancer Treatment Vol VIII Part B

are less active than cefazolin against staphylococci, theiruse promotes emergence of resistance, and they are moreexpensive than more effective alternatives 16 .6. In a small study investigating the contaminating bacteriain primary hip arthroplasty 17 and their sensitivity to theprophylactic antibiotics currently in use, impressions(627) of the gloved hands of the surgical team in 50total hip arthroplasties were obtained on blood agar. Thegloves were changed after draping, at intervals of 20minutes thereafter, and before using cement. Changeswere also undertaken whenever a visible puncture wasdetected. The culture plates were incubated at 37°C for48 hours. Isolates were identified and tested forsensitivity to flucloxacillin, which is a recognisedindicator of sensitivity to cefuroxime. They were alsotested against other agents depending upon theirappearance on Gram staining. Contamination wasdetected in 57 (9%) impressions and 106 bacterialisolates. Coagulase negative staphylococci were seenmost frequently (68.9%), but Micrococcus (12.3%),diphtheroids (9.4%), Staphylococcus aureus (6.6%) andEscherichia coli (0.9%) were also isolated. Of thecoagulase-negative staphylococci, only 52.1% weresensitive to flucloxacillin and therefore to cefuroxime.In another study from Wrightington Hospital, Wigan,UK,(9) where tissue samples were collected forbacteriological study during primary and revision hipsurgery, coagulase-negative staphylococcus was the mostcommon isolate (43.4%), 55% being methicillinresistant.In light of above, the authors question whethercefuroxime is the most appropriate agent for antibioticprophylaxis since staphylococci represented 75% ofcontaminating isolates, nearly half of which wereresistant to it. They recommend that the antibiotic policy126