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Even though it is widely used, there are concerns about the development of antibacterial resistance. The aim of the study was to investigate whether using ALBC in primary TJA increases the antibiotic\u2010resistant PJI. The hypothesis was that the regular use of ALBC does not increase the rate of resistant PJI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with confirmed PJI who had revision surgery from year 2010 to 2019 were included in this international multicenter study. The ALBC group was compared to the non\u2010ALBC TJA group from the same time period. Medical records were used to collect clinical (age, gender, body mass index, comorbidities), TJA\u2010related (type of operation, implant type and survival) and PJI\u2010related (cultured microorganism, antibiogram) data. Resistance to gentamicin, clindamycin and vancomycin were recorded from the antibiograms. Multiple logistic regression model was used to identify risk factors and account for the potential confounders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>218 patients with PJI were included in the study: 142 with gentamicin\u2010loaded bone cement and 76\u00a0in the non\u2010ALBC group. The average age in the ALBC group was 71\u2009\u00b1\u200910 years and 62\u2009\u00b1\u200912 years in the comparison group (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Coagulase negative Staphylococci (CONS) were the most common (49%) isolated pathogens. The use of ALBC did not increase the rate of any resistant bacteria significantly (OR\u2009=\u20090.79 (0.42\u20131.48), <jats:italic>p<\/jats:italic>\u2009=\u20090.469). The presence of CONS was associated with higher risk of antibiotic resistance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The current study demonstrates no increase in antibiotic resistance due to ALBC after primary TJA. Thus, the use of ALBC during primary TJA should not be feared in the context of antimicrobial resistance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-021-06649-x","type":"journal-article","created":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T12:33:51Z","timestamp":1625834031000},"page":"3208-3214","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["The use of antibiotic\u2010loaded bone cement does not increase antibiotic resistance after primary total joint arthroplasty"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2151-9031","authenticated-orcid":false,"given":"Kaspar","family":"Tootsi","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics Otto\u2010Von\u2010Guericke University Leipziger Str. 44 39120 Magdeburg Germany"},{"name":"<!--<label>2<\/label>--> Department of Traumatology and Orthopaedics University of Tartu Puusepa Str 8 51014 Tartu Estonia"},{"name":"<!--<label>3<\/label>--> Department of Orthopaedics Tartu University Hospital Puusepa Str 8 51014 Tartu Estonia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Heesen","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics Otto\u2010Von\u2010Guericke University Leipziger Str. 44 39120 Magdeburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Lohrengel","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics Otto\u2010Von\u2010Guericke University Leipziger Str. 44 39120 Magdeburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas Eugen","family":"Enz","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Klinik und Poliklinik f\u00fcr Orthop\u00e4die Universit\u00e4tsmedizin Rostock Doberaner Stra\u00dfe 142 18057 Rostock Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Illiger","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics Otto\u2010Von\u2010Guericke University Leipziger Str. 44 39120 Magdeburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfram","family":"Mittelmeier","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Klinik und Poliklinik f\u00fcr Orthop\u00e4die Universit\u00e4tsmedizin Rostock Doberaner Stra\u00dfe 142 18057 Rostock Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph H.","family":"Lohmann","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics Otto\u2010Von\u2010Guericke University Leipziger Str. 44 39120 Magdeburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,9]]},"reference":[{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0142\u20109612(01)00275\u20107"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2016.05.004"},{"key":"e_1_2_9_4_2","doi-asserted-by":"publisher","DOI":"10.1302\/2058\u20105241.4.180104"},{"key":"e_1_2_9_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006416\u2010200505000\u201000003"},{"key":"e_1_2_9_6_2","doi-asserted-by":"crossref","unstructured":"BistolfiA MassazzaG Vern\u00e9Eet al. 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