Meropenem has good tissue penetration and broad-spectrum bactericidal activity. Often employed to treat multiresistant Gram-negative organisms, meropenem was active against 98.7% of 1657 clinical surveillance Enterobacteriaceae isolates collected in the USA in 2005.1 Its stability permits combination with polymethylmethacrylate (PMMA) bone cement. We present here the first published account of the use of meropenem-loaded PMMA in human prosthetic joint infection.The patient, a 66-year-old woman with insulin-requiring type 2 diabetes, polymyalgia rheumatica (treated with 10 mg of predni-solone daily) and nodular prurigo, kindly gave written informed consent to publication. She was 170 cm tall and weighed 102 kg. She had had her left hip replaced for osteoarthritis at another institution in 1996. This prosthesis had functioned excellently for >10 years before becoming unstable; cup revision in September 2006 was complicated by formation of an infected haematoma. The joint was replaced again in October 2006 and the patient put on a long antibiotic course. Recurrent dislocation led to further socket revision in July 2007. The patient was referred to our specialist hip revision service with continuing instability in late 2008. On 17 February 2009, both components were revised. Seven operative tissue specimens were sterile. Antibiotic prophylaxis was with 48 h of vancomycin and gentamicin.
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