In patients with periprosthetic joint infection where surgery is not an option, Dr Ajdukiewicz highlighted the usefulness of continuous antibiotic suppression to manage the infection. Ideally, continuous antibiotic suppression should be associated with high bone penetration, low cumulative toxicity, low risk of drug—drug interactions, long half-life, minimal effect on the gut microbiome and be relatively convenient to take. In the UK, doxycycline, quinolones and cotrimoxazole are commonly used for continuous antibiotic suppression. However, there are limited data available to support the length of time that patients should receive continuous antibiotic suppression; this may contribute to the development of antibiotic resistance. In addition, Dr Ajdukiewicz outlined the role of multi-drug resistant (MDR) plasmids in the development of antibiotic resistance. MDR plasmids are small DNA molecules found in bacterial cells that develop as a result of gene mutations or by acquisition of resistance genes via horizontal gene transfer. Some MDR plasmids also promote biofilm development, thus improving the persistence of MDR plasmids.
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