Jerry Tsang | University of Edinburgh (original) (raw)

Papers by Jerry Tsang

Research paper thumbnail of Is There a Role for Antibiotic Suppression in the Management of Fracture-Related Infection Following Intramedullary Nailing?

Orthopaedic proceedings/Journal of bone and joint surgery. British volume. Orthopaedic proceedings, Apr 23, 2024

Research paper thumbnail of The Management of Critical Bone Defects: Outcomes of a Systematic Approach

Orthopaedic proceedings/Journal of bone and joint surgery. British volume. Orthopaedic proceedings, Apr 23, 2024

Research paper thumbnail of Extended Gram-Negative Cover Antibiotic Prophylaxis in Orthopaedic Trauma Surgery: Is It Time to Reconsider Current Practice?

Orthopaedic Proceedings, Nov 6, 2023

Research paper thumbnail of Critical Bone Defect Affecting the Outcome of Management in Anatomical Type IV Chronic Osteomyelitis

Orthopaedic Proceedings, Nov 6, 2023

Research paper thumbnail of Quality of Life in Osteomyelitis is Significantly Worse Compared to Other Chronic Diseases

Orthopaedic Proceedings

AimPatient quality of life (QoL) in untreated bone infection was compared to other chronic condit... more AimPatient quality of life (QoL) in untreated bone infection was compared to other chronic conditions and stratified by disease severity.MethodPatients referred for treatment of osteomyelitis (including fracture related infection) were identified prospectively between 2019 and 2023. Patients with confirmed infection completed the EuroQol EQ-5D-5L questionnaire. Clinicians blinded to EQ-index score, grouped patients according to JS-BACH Classification into ‘Uncomplicated’, ‘Complex’ or ‘Limited treatment options’. A systematic review of the literature was performed of other conditions that have been stratified using EQ-index score.Results257 patients were referred, and 219 had suspected osteomyelitis. 196 patients had long bone infection and reported an average EQ-index score of 0.455 (SD 0.343). 23 patients with pelvic osteomyelitis had an average EQ-index score of 0.098 (SD 0.308). Compared to other chronic conditions, patients with long-bone osteomyelitis had worse QoL when compar...

Research paper thumbnail of Single-Stage, Combined, Ortho-Plastics Treatment of Severe Calcaneal Osteomyelitis with Large Soft-Tissue Defects: Long-Term Follow-Up

Orthopaedic Proceedings

AimCalcaneal osteomyelitis remains a difficult condition to treat with high rates of recurrence a... more AimCalcaneal osteomyelitis remains a difficult condition to treat with high rates of recurrence and below knee amputation; particularly in cases of severe soft tissue destruction. This study assesses the outcomes of combined ortho-plastics treatment of complex calcaneal osteomyelitis.MethodA retrospective review was performed of all patients who underwent combined single stage ortho-plastics treatment of calcaneal osteomyelitis (2008- 2022). Primary outcome measures were osteomyelitis recurrence and BKA. Secondary outcome measures included flap failure, operative time, complications, length of stay.Results33 patients (16 female, 17 male, mean age = 54.4 years) underwent combined ortho-plastics surgical treatment for BACH “complex” calcaneal osteomyelitis with a median follow-up of 31 months (s.d. 24.3). 20 received a local flap, 13 received a free flap. Fracture-related infection (39%) and diabetic ulceration (33%) were the commonest causes. 54% of patients had already undergone at ...

Research paper thumbnail of Managing fracture-related infection

Research paper thumbnail of Exchange nailing for femoral diaphyseal fracture non-unions: Risk factors for failure

Injury-international Journal of The Care of The Injured, Dec 1, 2015

The aim of this study was to identify risk factors for failure of exchange nailing for femoral di... more The aim of this study was to identify risk factors for failure of exchange nailing for femoral diaphyseal fracture non-unions. The study cohort comprised 40 patients with femoral diaphyseal non-unions treated by exchange nailing, of which six were open injuries. The median time to exchange nailing from primary fixation was 8.4 months. The main outcome measures were union, number of secondary fixation procedures required to achieve union and time to union. Multiple causes for non-union were found in 16 (40%) cases, with infection present in 12 (30.0%) patients. Further surgical procedures were required in nine (22.5%) cases, one of whom (2.5%) required the use of another fixation modality to achieve union. Union was ultimately achieved with exchange nailing in 34/37 (91.9%) patients. The median time to union after the exchange nailing was 9.4 months. Cigarette smoking and infection were risk factors for failure of exchange nailing. Multivariate analysis found infection to be the strongest predictor of exchange failure (p<0.05). Exchange nailing is an effective treatment for aseptic femoral diaphyseal fracture non-union. However, 50% of patients undergoing exchange nailing in the presence of infection required at least one further procedure. It is important to counsel patients of this so that they can plan for it and do not consider that the first exchange operation has failed.

Research paper thumbnail of Exchange nailing for nonunion of diaphyseal fractures of the tibia

The bone & joint journal, Apr 1, 2016

The aim of this study was to identify risk factors for the failure of exchange nailing in nonunio... more The aim of this study was to identify risk factors for the failure of exchange nailing in nonunion of tibial diaphyseal fractures.

Research paper thumbnail of When does hip fracture surgery fail?

Injury-international Journal of The Care of The Injured, Jul 1, 2014

Hip fractures remain the most common orthopaedic injury requiring hospital admission. Failed surg... more Hip fractures remain the most common orthopaedic injury requiring hospital admission. Failed surgery for any cause carries a higher morbidity, mortality, and healthcare-related cost. The aims of this study were to determine risk factors for surgical complications of hip fracture surgery, when they occurred and their effect on mortality. From a prospectively collected consecutive database of 795 hip fractures admitted between July 2007 and June 2008, all surgical and non-surgical complications were identified as well as re-operation for any cause and mortality in the 4 years since surgery. Fifty-five (6.9%) patients were found to have developed a surgical complication requiring further intervention. Risk factors included younger age, smoking and cannulated screw fixation. Cannulated screw fixation was associated with a 30.9% rate of re-operation. Post-operative medical complication occurred in 21.8%. It was associated with a 78.5% mortality at 4 years with a median time to mortality of 58 days (95% CI 0-120 days). Mechanical failure was the most common reason for cannulated screw re-operation. Hip hemiarthroplasty most commonly failed by infection. Inter-trochanteric and sub-trochanteric fracture fixation had very low failure rates. Post-operative medical complications, but not surgical complications, were associated with a higher mortality rate.

Research paper thumbnail of Adverse peri-operative outcomes following elective total hip replacement in diabetes mellitus

The bone & joint journal, Nov 1, 2013

Total hip replacement (THR) has been shown to be a cost-effective procedure. However, it is not r... more Total hip replacement (THR) has been shown to be a cost-effective procedure. However, it is not risk-free. Certain conditions, such as diabetes mellitus, are thought to increase the risk of complications. In this study we have evaluated the prevalence of diabetes mellitus in patients undergoing THR and the associated risk of adverse operative outcomes. A metaanalysis and systematic review were conducted according to the guidelines of the metaanalysis of observational studies in epidemiology. Inclusion criteria were observational studies reporting the prevalence of diabetes in the study population, accompanied by reports of at least one of the following outcomes: venous thromboembolic events; acute coronary events; infections of the urinary tract, lower respiratory tract or surgical site; or requirement for revision arthroplasty. Altman and Bland's methods were used to calculate differences in relative risks. The prevalence of diabetes mellitus was found to be 5.0% among patients undergoing THR, and was associated with an increased risk of established surgical site infection (odds ratio (OR) 2.04 (95% confidence interval (CI) 1.52 to 2.76)), urinary infection (OR 1.43 (95% CI 1.33 to 1.55)) and lower respiratory tract infections (OR 1.95 (95% CI 1.61 to 2.26)). Diabetes mellitus is a relatively common comorbidity encountered in THR. Diabetic patients have a higher rate of developing both surgical site and non-surgical site infections following THR.

Research paper thumbnail of A cohort study of tibialis anterior tendon shortening in combination with calf muscle lengthening in spastic equinus in cerebral palsy

Gait & Posture, Oct 1, 2016

Research paper thumbnail of A Metabolomic Study Into the Effect of Non-Lethal Dispersion on Antimicrobial Tolerance in Staphylococcus Aureus Biofilms

Orthopaedic Proceedings, Mar 1, 2021

Research paper thumbnail of Effect of Low-Intensity Pulsed Ultrasound Therapy on Staphylococcus Aureus Biofilms

Orthopaedic Proceedings, Jan 22, 2019

Staphylococcus aureus is responsible for 60–70% infections of surgical implants and prostheses in... more Staphylococcus aureus is responsible for 60–70% infections of surgical implants and prostheses in Orthopaedic surgery, costing the NHS £120–200 million per annum. Its ability to develop resistance ...

Research paper thumbnail of The reconstruction of critical bone loss

Bone & Joint Research

Research paper thumbnail of Relevance of a bone and joint registry for fracture-related infections

Research paper thumbnail of Underestimation of Staphylococcus Aureus Carriage Associated with Standard Culturing Techniques

Journal of Bone and Joint Surgery-british Volume, 2017

Nasal carriers of methicillin sensitive Staphylococcus aureus (MSSA) have an increased risk for h... more Nasal carriers of methicillin sensitive Staphylococcus aureus (MSSA) have an increased risk for health-care associated infections. There is currently no national screening policy for the detection ...

Research paper thumbnail of What is the role of ultrasound in fracture management?

Bone & Joint Research, 2019

ObjectivesThe aim of this study was to review the current evidence and future application for the... more ObjectivesThe aim of this study was to review the current evidence and future application for the role of diagnostic and therapeutic ultrasound in fracture management.MethodsA review of relevant literature was undertaken, including articles indexed in PubMed with keywords “ultrasound” or “sonography” combined with “diagnosis”, “fracture healing”, “impaired fracture healing”, “nonunion”, “microbiology”, and “fracture-related infection”.ResultsThe use of ultrasound in musculoskeletal medicine has expanded rapidly over the last two decades, but the diagnostic use in fracture management is not routinely practised. Early studies have shown the potential of ultrasound as a valid alternative to radiographs to diagnose common paediatric fractures, to detect occult injuries in adults, and for rapid detection of long bone fractures in the resuscitation setting. Ultrasound has also been shown to be advantageous in the early identification of impaired fracture healing; with the advent of 3D ima...

Research paper thumbnail of Non-union: Indications for external fixation

Injury, 2019

External fixation is currently used as the definitive mode of fracture stabilisation in the manag... more External fixation is currently used as the definitive mode of fracture stabilisation in the management of ~50% of long-bone non-unions. Distinction between non-union and delayed union is a diagnostic dilemma especially in fractures healing by primary bone repair. This distinction is important, as non-unions are not necessarily part of the same spectrum as delayed unions. The aetiology of a fracture non-union is usually multifactorial and the factors can be broadly categorized into mechanical factors, biological (local and systemic) factors, and infection. Infection is present iñ 40% of fracture non-unions, often after open fractures or impaired wound healing, but in 5% of all non-unions infection is present without any clinical or serological suspicion. General indications for external fixation include clinical scenarios where; 1) percutaneous correction of alignment, or mechanical stimulation of the non-union site is required; 2) fixation of juxta-articular or 'emmental' bone fragments is necessary; and 3) staged bone or soft tissue reconstruction is anticipated. Specific anatomical indications include infected non-unions of the tibia, humerus, and juxta-articular bone. External fixation is an essential tool in the management of fracture non-unions. However, with greater understanding of the outcomes associated with both external and internal fixation the relative indications are now being refined.

Research paper thumbnail of Unexpected synergistic and antagonistic antibiotic activity against Staphylococcus biofilms

Journal of Antimicrobial Chemotherapy, 2018

To evaluate putative anti-staphylococcal biofilm antibiotic combinations used in the management o... more To evaluate putative anti-staphylococcal biofilm antibiotic combinations used in the management of periprosthetic joint infections (PJIs). Methods: Using the dissolvable bead biofilm assay, the minimum biofilm eradication concentration (MBEC) was determined for the most commonly used antimicrobial agents and combination regimens against staphylococcal PJIs. The established fractional inhibitory concentration (FIC) index was modified to create the fractional biofilm eradication concentration (FBEC) index to evaluate synergism or antagonism between antibiotics. Results: Only gentamicin (MBEC 64 mg/L) and daptomycin (MBEC 64 mg/L) were observed to be effective antistaphylococcal agents at clinically achievable concentrations. Supplementation of gentamicin with daptomycin, vancomycin or ciprofloxacin resulted in a similar or lower MBEC than gentamicin alone (FBEC index 0.25-2). Conversely, when rifampicin, clindamycin or linezolid was added to gentamicin, there was an increase in the MBEC of gentamicin relative to its use as a monotherapy (FBEC index 8-32). Conclusions: This study found that gentamicin and daptomycin were the only effective single-agent antibiotics against established Staphylococcus biofilms. Interestingly the addition of a bacteriostatic antibiotic was found to antagonize the ability of gentamicin to eradicate Staphylococcus biofilms.

Research paper thumbnail of Is There a Role for Antibiotic Suppression in the Management of Fracture-Related Infection Following Intramedullary Nailing?

Orthopaedic proceedings/Journal of bone and joint surgery. British volume. Orthopaedic proceedings, Apr 23, 2024

Research paper thumbnail of The Management of Critical Bone Defects: Outcomes of a Systematic Approach

Orthopaedic proceedings/Journal of bone and joint surgery. British volume. Orthopaedic proceedings, Apr 23, 2024

Research paper thumbnail of Extended Gram-Negative Cover Antibiotic Prophylaxis in Orthopaedic Trauma Surgery: Is It Time to Reconsider Current Practice?

Orthopaedic Proceedings, Nov 6, 2023

Research paper thumbnail of Critical Bone Defect Affecting the Outcome of Management in Anatomical Type IV Chronic Osteomyelitis

Orthopaedic Proceedings, Nov 6, 2023

Research paper thumbnail of Quality of Life in Osteomyelitis is Significantly Worse Compared to Other Chronic Diseases

Orthopaedic Proceedings

AimPatient quality of life (QoL) in untreated bone infection was compared to other chronic condit... more AimPatient quality of life (QoL) in untreated bone infection was compared to other chronic conditions and stratified by disease severity.MethodPatients referred for treatment of osteomyelitis (including fracture related infection) were identified prospectively between 2019 and 2023. Patients with confirmed infection completed the EuroQol EQ-5D-5L questionnaire. Clinicians blinded to EQ-index score, grouped patients according to JS-BACH Classification into ‘Uncomplicated’, ‘Complex’ or ‘Limited treatment options’. A systematic review of the literature was performed of other conditions that have been stratified using EQ-index score.Results257 patients were referred, and 219 had suspected osteomyelitis. 196 patients had long bone infection and reported an average EQ-index score of 0.455 (SD 0.343). 23 patients with pelvic osteomyelitis had an average EQ-index score of 0.098 (SD 0.308). Compared to other chronic conditions, patients with long-bone osteomyelitis had worse QoL when compar...

Research paper thumbnail of Single-Stage, Combined, Ortho-Plastics Treatment of Severe Calcaneal Osteomyelitis with Large Soft-Tissue Defects: Long-Term Follow-Up

Orthopaedic Proceedings

AimCalcaneal osteomyelitis remains a difficult condition to treat with high rates of recurrence a... more AimCalcaneal osteomyelitis remains a difficult condition to treat with high rates of recurrence and below knee amputation; particularly in cases of severe soft tissue destruction. This study assesses the outcomes of combined ortho-plastics treatment of complex calcaneal osteomyelitis.MethodA retrospective review was performed of all patients who underwent combined single stage ortho-plastics treatment of calcaneal osteomyelitis (2008- 2022). Primary outcome measures were osteomyelitis recurrence and BKA. Secondary outcome measures included flap failure, operative time, complications, length of stay.Results33 patients (16 female, 17 male, mean age = 54.4 years) underwent combined ortho-plastics surgical treatment for BACH “complex” calcaneal osteomyelitis with a median follow-up of 31 months (s.d. 24.3). 20 received a local flap, 13 received a free flap. Fracture-related infection (39%) and diabetic ulceration (33%) were the commonest causes. 54% of patients had already undergone at ...

Research paper thumbnail of Managing fracture-related infection

Research paper thumbnail of Exchange nailing for femoral diaphyseal fracture non-unions: Risk factors for failure

Injury-international Journal of The Care of The Injured, Dec 1, 2015

The aim of this study was to identify risk factors for failure of exchange nailing for femoral di... more The aim of this study was to identify risk factors for failure of exchange nailing for femoral diaphyseal fracture non-unions. The study cohort comprised 40 patients with femoral diaphyseal non-unions treated by exchange nailing, of which six were open injuries. The median time to exchange nailing from primary fixation was 8.4 months. The main outcome measures were union, number of secondary fixation procedures required to achieve union and time to union. Multiple causes for non-union were found in 16 (40%) cases, with infection present in 12 (30.0%) patients. Further surgical procedures were required in nine (22.5%) cases, one of whom (2.5%) required the use of another fixation modality to achieve union. Union was ultimately achieved with exchange nailing in 34/37 (91.9%) patients. The median time to union after the exchange nailing was 9.4 months. Cigarette smoking and infection were risk factors for failure of exchange nailing. Multivariate analysis found infection to be the strongest predictor of exchange failure (p<0.05). Exchange nailing is an effective treatment for aseptic femoral diaphyseal fracture non-union. However, 50% of patients undergoing exchange nailing in the presence of infection required at least one further procedure. It is important to counsel patients of this so that they can plan for it and do not consider that the first exchange operation has failed.

Research paper thumbnail of Exchange nailing for nonunion of diaphyseal fractures of the tibia

The bone & joint journal, Apr 1, 2016

The aim of this study was to identify risk factors for the failure of exchange nailing in nonunio... more The aim of this study was to identify risk factors for the failure of exchange nailing in nonunion of tibial diaphyseal fractures.

Research paper thumbnail of When does hip fracture surgery fail?

Injury-international Journal of The Care of The Injured, Jul 1, 2014

Hip fractures remain the most common orthopaedic injury requiring hospital admission. Failed surg... more Hip fractures remain the most common orthopaedic injury requiring hospital admission. Failed surgery for any cause carries a higher morbidity, mortality, and healthcare-related cost. The aims of this study were to determine risk factors for surgical complications of hip fracture surgery, when they occurred and their effect on mortality. From a prospectively collected consecutive database of 795 hip fractures admitted between July 2007 and June 2008, all surgical and non-surgical complications were identified as well as re-operation for any cause and mortality in the 4 years since surgery. Fifty-five (6.9%) patients were found to have developed a surgical complication requiring further intervention. Risk factors included younger age, smoking and cannulated screw fixation. Cannulated screw fixation was associated with a 30.9% rate of re-operation. Post-operative medical complication occurred in 21.8%. It was associated with a 78.5% mortality at 4 years with a median time to mortality of 58 days (95% CI 0-120 days). Mechanical failure was the most common reason for cannulated screw re-operation. Hip hemiarthroplasty most commonly failed by infection. Inter-trochanteric and sub-trochanteric fracture fixation had very low failure rates. Post-operative medical complications, but not surgical complications, were associated with a higher mortality rate.

Research paper thumbnail of Adverse peri-operative outcomes following elective total hip replacement in diabetes mellitus

The bone & joint journal, Nov 1, 2013

Total hip replacement (THR) has been shown to be a cost-effective procedure. However, it is not r... more Total hip replacement (THR) has been shown to be a cost-effective procedure. However, it is not risk-free. Certain conditions, such as diabetes mellitus, are thought to increase the risk of complications. In this study we have evaluated the prevalence of diabetes mellitus in patients undergoing THR and the associated risk of adverse operative outcomes. A metaanalysis and systematic review were conducted according to the guidelines of the metaanalysis of observational studies in epidemiology. Inclusion criteria were observational studies reporting the prevalence of diabetes in the study population, accompanied by reports of at least one of the following outcomes: venous thromboembolic events; acute coronary events; infections of the urinary tract, lower respiratory tract or surgical site; or requirement for revision arthroplasty. Altman and Bland's methods were used to calculate differences in relative risks. The prevalence of diabetes mellitus was found to be 5.0% among patients undergoing THR, and was associated with an increased risk of established surgical site infection (odds ratio (OR) 2.04 (95% confidence interval (CI) 1.52 to 2.76)), urinary infection (OR 1.43 (95% CI 1.33 to 1.55)) and lower respiratory tract infections (OR 1.95 (95% CI 1.61 to 2.26)). Diabetes mellitus is a relatively common comorbidity encountered in THR. Diabetic patients have a higher rate of developing both surgical site and non-surgical site infections following THR.

Research paper thumbnail of A cohort study of tibialis anterior tendon shortening in combination with calf muscle lengthening in spastic equinus in cerebral palsy

Gait & Posture, Oct 1, 2016

Research paper thumbnail of A Metabolomic Study Into the Effect of Non-Lethal Dispersion on Antimicrobial Tolerance in Staphylococcus Aureus Biofilms

Orthopaedic Proceedings, Mar 1, 2021

Research paper thumbnail of Effect of Low-Intensity Pulsed Ultrasound Therapy on Staphylococcus Aureus Biofilms

Orthopaedic Proceedings, Jan 22, 2019

Staphylococcus aureus is responsible for 60–70% infections of surgical implants and prostheses in... more Staphylococcus aureus is responsible for 60–70% infections of surgical implants and prostheses in Orthopaedic surgery, costing the NHS £120–200 million per annum. Its ability to develop resistance ...

Research paper thumbnail of The reconstruction of critical bone loss

Bone & Joint Research

Research paper thumbnail of Relevance of a bone and joint registry for fracture-related infections

Research paper thumbnail of Underestimation of Staphylococcus Aureus Carriage Associated with Standard Culturing Techniques

Journal of Bone and Joint Surgery-british Volume, 2017

Nasal carriers of methicillin sensitive Staphylococcus aureus (MSSA) have an increased risk for h... more Nasal carriers of methicillin sensitive Staphylococcus aureus (MSSA) have an increased risk for health-care associated infections. There is currently no national screening policy for the detection ...

Research paper thumbnail of What is the role of ultrasound in fracture management?

Bone & Joint Research, 2019

ObjectivesThe aim of this study was to review the current evidence and future application for the... more ObjectivesThe aim of this study was to review the current evidence and future application for the role of diagnostic and therapeutic ultrasound in fracture management.MethodsA review of relevant literature was undertaken, including articles indexed in PubMed with keywords “ultrasound” or “sonography” combined with “diagnosis”, “fracture healing”, “impaired fracture healing”, “nonunion”, “microbiology”, and “fracture-related infection”.ResultsThe use of ultrasound in musculoskeletal medicine has expanded rapidly over the last two decades, but the diagnostic use in fracture management is not routinely practised. Early studies have shown the potential of ultrasound as a valid alternative to radiographs to diagnose common paediatric fractures, to detect occult injuries in adults, and for rapid detection of long bone fractures in the resuscitation setting. Ultrasound has also been shown to be advantageous in the early identification of impaired fracture healing; with the advent of 3D ima...

Research paper thumbnail of Non-union: Indications for external fixation

Injury, 2019

External fixation is currently used as the definitive mode of fracture stabilisation in the manag... more External fixation is currently used as the definitive mode of fracture stabilisation in the management of ~50% of long-bone non-unions. Distinction between non-union and delayed union is a diagnostic dilemma especially in fractures healing by primary bone repair. This distinction is important, as non-unions are not necessarily part of the same spectrum as delayed unions. The aetiology of a fracture non-union is usually multifactorial and the factors can be broadly categorized into mechanical factors, biological (local and systemic) factors, and infection. Infection is present iñ 40% of fracture non-unions, often after open fractures or impaired wound healing, but in 5% of all non-unions infection is present without any clinical or serological suspicion. General indications for external fixation include clinical scenarios where; 1) percutaneous correction of alignment, or mechanical stimulation of the non-union site is required; 2) fixation of juxta-articular or 'emmental' bone fragments is necessary; and 3) staged bone or soft tissue reconstruction is anticipated. Specific anatomical indications include infected non-unions of the tibia, humerus, and juxta-articular bone. External fixation is an essential tool in the management of fracture non-unions. However, with greater understanding of the outcomes associated with both external and internal fixation the relative indications are now being refined.

Research paper thumbnail of Unexpected synergistic and antagonistic antibiotic activity against Staphylococcus biofilms

Journal of Antimicrobial Chemotherapy, 2018

To evaluate putative anti-staphylococcal biofilm antibiotic combinations used in the management o... more To evaluate putative anti-staphylococcal biofilm antibiotic combinations used in the management of periprosthetic joint infections (PJIs). Methods: Using the dissolvable bead biofilm assay, the minimum biofilm eradication concentration (MBEC) was determined for the most commonly used antimicrobial agents and combination regimens against staphylococcal PJIs. The established fractional inhibitory concentration (FIC) index was modified to create the fractional biofilm eradication concentration (FBEC) index to evaluate synergism or antagonism between antibiotics. Results: Only gentamicin (MBEC 64 mg/L) and daptomycin (MBEC 64 mg/L) were observed to be effective antistaphylococcal agents at clinically achievable concentrations. Supplementation of gentamicin with daptomycin, vancomycin or ciprofloxacin resulted in a similar or lower MBEC than gentamicin alone (FBEC index 0.25-2). Conversely, when rifampicin, clindamycin or linezolid was added to gentamicin, there was an increase in the MBEC of gentamicin relative to its use as a monotherapy (FBEC index 8-32). Conclusions: This study found that gentamicin and daptomycin were the only effective single-agent antibiotics against established Staphylococcus biofilms. Interestingly the addition of a bacteriostatic antibiotic was found to antagonize the ability of gentamicin to eradicate Staphylococcus biofilms.