scholarly journals Heterogeneity of Staphylococcus epidermidis in prosthetic joint infections: Time to reevaluate microbiological criteria?

2021 ◽  
Author(s):  
Micael Widerstrom ◽  
Marc Stegger ◽  
Anders Johansson ◽  
Bharat Kumar Gurram ◽  
Anders Rhod Larsen ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Staphylococcus Epidermidis ◽  
Joint Infection ◽  
Antibiotic Resistance Gene ◽  
Whole Genome Sequence ◽  
Clonal Variation ◽  
Whole Genome ◽  
Coagulase Negative Staphylococci ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Prosthetic joint infection (PJI) is a feared complication after arthroplasty with Staphylococcus epidermidis as a major pathogen. One diagnostic criteria for PJI diagnosis is the finding of phenotypically identical organisms based on common laboratory tests in two or more periprosthetic microbial cultures. Because of phenotypical variation within a genetic clone, and clonal variation within a phenotype, the criteria may be ambiguous. Here, we investigate the extent of diversity among coagulase-negative staphylococci in PJI and characterize in detail S. epidermidis isolates from these infections. We performed a retrospective cohort study of 62 consecutive patients with PJI caused by coagulase-negative staphylococci (CoNS) in two hospitals in Northern Sweden. From 16 of the patients, two to nine S. epidermidis isolates were available for whole-genome sequence analyses.Hospital-adapted multidrug-resistant genetic clones of S. epidermidis were identified in 40/62 (65%) of the PJIs using a combination of analysis by pulsed-field gel electrophoresis and multiple-locus sequence typing. Whole genome sequencing showed presence of multiple sequence types (STs) in seven (44%) PJIs. Among isolates of the same ST, within-patient phenotypical variation in antibiotic susceptibility and/or whole-genome antibiotic resistance gene content was frequent (11/16, 69%).These results highlight the ambiguity of using phenotypical characterization of S. epidermidis as diagnostic criteria in PJI. The results call for larger systematic studies to determine the frequency of CoNS diversity in PJIs, the implications of such diversity for microbiological diagnostics, and for the therapeutic outcome in patients.

scholarly journals Heterogeneity of Staphylococcus epidermidis in prosthetic joint infections: time to reevaluate microbiological criteria?

2021 ◽  
Author(s):  
Micael Widerström ◽  
Marc Stegger ◽  
Anders Johansson ◽  
Bharat Kumar Gurram ◽  
Anders Rhod Larsen ◽  
...  
Keyword(s):  
Staphylococcus Epidermidis ◽  
Antibiotic Susceptibility ◽  
Joint Infection ◽  
Antibiotic Resistance Gene ◽  
Clonal Variation ◽  
Whole Genome ◽  
Multiple Sequence ◽  
Prosthetic Joint ◽  
Phenotypic Characterisation ◽  
Prosthetic Joint Infections

Abstract Prosthetic joint infection (PJI) is a feared and challenging to diagnose complication after arthroplasty, with Staphylococcus epidermidis as the major pathogen. One important criteria to define PJI is the detection of phenotypically indistinguishable microorganisms with identical antibiotic susceptibility pattern in at least two different samples. However, owing to phenotypical variation within genetic clones and clonal variation within a phenotype, the criteria may be ambiguous. We investigated the extent of diversity among coagulase-negative staphylococci (CoNS) in PJI and characterised S. epidermidis isolates from PJI samples, specifically multiple S. epidermidis isolates identified in individual PJI patients. We performed a retrospective cohort study on 62 consecutive patients with PJI caused by CoNS from two hospitals in Northern Sweden. In 16/62 (26%) PJIs, multiple S. epidermidis isolates were available for whole-genome analyses. Hospital-adapted multidrug-resistant genetic clones of S. epidermidis were identified in samples from 40/62 (65%) of the patients using a combination of pulsed-field gel electrophoresis and multilocus sequence typing. Whole-genome sequencing showed the presence of multiple sequence types (STs) in 7/16 (44%) PJIs where multiple S. epidermidis isolates were available. Within-patient phenotypical variation in the antibiotic susceptibility and/or whole-genome antibiotic resistance gene content was frequent (11/16, 69%) among isolates with the same ST. The results highlight the ambiguity of S. epidermidis phenotypic characterisation as a diagnostic method in PJI and call for larger systematic studies for determining the frequency of CoNS diversity in PJIs, the implications of such diversity for microbiological diagnostics, and the therapeutic outcomes in patients.

Characterization of Staphylococcus epidermidis and Staphyloccocus warneri small-colony variants associated with prosthetic-joint infections

2014 ◽  
Vol 63 (2) ◽  
pp. 176-185 ◽  
Author(s):  
Agnieszka Bogut ◽  
Justyna Niedźwiadek ◽  
Maria Kozioł-Montewka ◽  
Dagmara Strzelec-Nowak ◽  
Jan Blacha ◽  
...  
Keyword(s):  
Antimicrobial Susceptibility ◽  
Staphylococcus Epidermidis ◽  
Hip Prosthesis ◽  
Joint Infection ◽  
Coagulase Negative Staphylococci ◽  
Sensitivity Testing ◽  
Small Colony Variants ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Small Colony

We determined the frequency of isolation of staphylococcal small-colony variants (SCVs) from 31 culture-positive patients undergoing revision of total hip prosthesis for aseptic loosening or presumed prosthetic-joint infection (PJI). We analysed auxotrophy of cultured SCVs, their antimicrobial susceptibility profiles and their biofilm-forming capacity. Eight SCV strains were cultivated from six (19 %) patients. All SCVs were coagulase-negative staphylococci (CNS) with Staphylococcus epidermidis as the predominant species; there was also one Staphylococcus warneri SCV. The SCVs were auxotrophic for haemin, with one strain additionally auxotrophic for menadione. We noted the presence of two phenotypically (differences concerning antimicrobial susceptibility) and genetically distinct SCV strains in one patient, as well as the growth of two genetically related SCVs that differed in terms of their morphology and the type of auxotrophy in another. Seven out of eight SCVs were resistant to meticillin and gentamicin. In addition, antibiotic sensitivity testing revealed three multidrug-resistant SCV–normal-morphology isolate pairs. One S. epidermidis SCV harboured icaADBC genes and was found to be a proficient biofilm producer. This paper highlights the involvement of CNS SCVs in the aetiology of PJIs, including what is believed to be the first report of a S. warneri SCV. These subpopulations must be actively sought in the routine diagnosis of implant-associated infections. Moreover, in view of the phenotypic and genetic diversity of some SCV pairs, particular attention should be paid to the investigation of all types of observed colony morphologies, and isolates should be subjected to antimicrobial susceptibility testing.

scholarly journals The impact of sonication cultures when the diagnosis of prosthetic joint infection is inconclusive

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0252322
Author(s):  
Taiana Cunha Ribeiro ◽  
Emerson Kiyoshi Honda ◽  
Daniel Daniachi ◽  
Ricardo de Paula Leite Cury ◽  
Cely Barreto da Silva ◽  
...  
Keyword(s):  
Tissue Culture ◽  
Diagnostic Criteria ◽  
Gold Standard ◽  
Joint Infection ◽  
Clinical Criterion ◽  
Tissue Cultures ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
The Impact ◽  
Sonication Culture

Background In the absence of a gold standard criterion for diagnosing prosthetic joint infections (PJI), sonication of the removed implant may provide superior microbiological identification to synovial fluid and peri-implant tissue cultures. The aim of this retrospective study was to assess the role of sonication culture compared to tissue cultures for diagnosing PJI, using different consensus and international guidelines for PJI definition. Methods Data of 146 patients undergoing removal of hip or knee arthroplasties between 2010 and 2018 were retrospectively reviewed. The International Consensus Meeting (ICM-2018), Musculoskeletal Infection Society (MSIS), Infectious Diseases Society of America (IDSA), the European Bone and Joint Infection Society (EBJIS), and a modified clinical criterion, were used to compare the performance of microbiological tests. McNemar´s test and proportion comparison were employed to calculate p-value. Results Overall, 56% (82/146) were diagnosed with PJI using the clinical criteria. Out of these cases, 57% (47/82) tested positive on tissue culture and 93% (76/82) on sonication culture. Applying this clinical criterion, the sensitivity of sonication fluid and tissue cultures was 92.7% (95% CI: 87.1%- 98.3%) and 57.3% (95% CI: 46.6%-68.0%) (p<0.001), respectively. When both methods were combined for diagnosis (sonication and tissue cultures) sensitivity reached 96.3% (95% CI: 91.5%-100%). Sonication culture and the combination of sonication with tissue cultures, showed higher sensitivity rates than tissue cultures alone for all diagnostic criteria (ICM-18, MSIS, IDSA and EBJIS) applied. Conversely, tissue culture provided greater specificity than sonication culture for all the criteria assessed, except for the EBJIS criteria, in which sonication and tissue cultures specificity was 100% and 95.3% (95% CI: 87.8–100%), respectively (p = 0.024). Conclusions In a context where diagnostic criteria available have shortcomings and tissue cultures remain the gold standard, sonication cultures can aid PJI diagnosis, especially when diagnostic criteria are inconclusive due to some important missing data (joint puncture, histology).

scholarly journals Bacterial Extracellular DNA Production Is Associated with Outcome of Prosthetic Joint Infections

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Beata Zatorska ◽  
Carla Renata Arciola ◽  
Nicolas Haffner ◽  
Luigi Segagni Lusignani ◽  
Elisabeth Presterl ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Staphylococcus Epidermidis ◽  
Joint Infection ◽  
Surrogate Marker ◽  
Predictive Marker ◽  
Extracellular Dna ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Dna Production

In a retrospective study the association of the production of extracellular DNA (eDNA) in biofilms of clinical staphylococcal isolates from 60 patients with prosthetic joint infection (PJI) and the clinical outcome were investigated. Data from a previous study on eDNA production determined in 24-hour biofilms of staphylococcal isolates (Staphylococcus aureusn=30,Staphylococcus epidermidisn=30) was correlated with the patients’ clinical outcome after 3 and 12 months. Statistical analysis was performed using either the Spearman’s rank correlations test or the t-test. eDNA production ofS. epidermidisin 24-hour biofilms correlated with the patients’ outcome ‘not cured‘ after 12 months. ForS. aureusno such correlation was detected. Thus, eDNA may be a virulence factor ofS. epidermidis.Quantification of eDNA production as a surrogate marker for biofilm formation might be a potential predictive marker for the management of PJI.

scholarly journals Clinical Experience with Tigecycline in the Treatment of Prosthetic Joint Infections

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S98-S98
Author(s):  
Allison Lastinger ◽  
Matthew Dietz ◽  
John Guilfoose ◽  
Arif R Sarwari
Keyword(s):  
Demographic Data ◽  
Joint Infection ◽  
Treatment Success ◽  
The United States ◽  
Empiric Therapy ◽  
Common Adverse Event ◽  
Coagulase Negative Staphylococci ◽  
Successful Treatment Outcome ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Abstract Background As the population in the United States ages, the number of people who will require a joint arthroplasty is expected to rise dramatically. The most serious complication of this surgery is prosthetic joint infection (PJI) which can lead to long-term morbidity and even mortality. Biofilms play a major role in these infections, and studies have suggested that tigecycline may work better than other antimicrobials in the setting of biofilms. In this study, we examined our institution’s experience with using tigecycline to treat PJI. Methods This was a retrospective review of all adult patients with PJI treated at West Virginia University from January 2008 to March 2016 who received tigecycline for 50% or greater of the treatment course. Demographic data, rationale for tigecycline use, type of surgery, microbiologic data, outcome and complications were assessed. Failure was defined as need to return to the operating room for an infectious complication or persistent drainage from the joint. Results In total, 34 patients met inclusion criteria. The median age was 65 years, and 62% of the patients were female. The most common reason for tigecycline use was empiric therapy, but other reasons included antimicrobial allergies and resistant organisms. The antimicrobial was used as frontline therapy in 29 cases (85%), and the mean duration of tigecycline therapy was 38 days. The most common organisms isolated were methicillin resistant Staphylococcus aureus (n = 7), coagulase negative Staphylococci (n = 5), and Enterococcus species (n = 4), but 12 cases (35%) were culture negative. Treatment success was documented for 21 cases (62%); though, there was limited follow-up (2 months or less) in four of the successful cases. Nausea and vomiting was the most common adverse event, occurring in three patients. Conclusion Tigecycline is a glycylcycline approved for use in a variety of infections including intra-abdominal and skin soft-tissue infections, but little is known about its use in the treatment of PJI. We found that tigecycline is well tolerated even when given for 6 weeks duration. Twenty-one of the 34 patients (62%) met our definition of successful treatment outcome with tigecycline. More studies are needed to assess tigecycline’s use in the treatment of PJI. Disclosures All authors: No reported disclosures.

scholarly journals Multidrug-Resistant Gram-Negative bacilli Prosthetic Joint Infection: A Worrisome Scenario

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S97-S97
Author(s):  
Taiana Ribeiro ◽  
Giselle Klautau ◽  
Mauro Salles ◽  
Keyword(s):  
Joint Infection ◽  
Multidrug Resistant ◽  
Adult Patients ◽  
Tissue Cultures ◽  
Knee Prostheses ◽  
Coagulase Negative Staphylococci ◽  
Gram Negative ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Fluid Culture

Abstract Background The spectrum of the microbial etiology of prosthetic joint infections (PJIs) is changing, with a higher occurrence of Gram-negative bacilli (GNB) nowadays. In Latine America, GNB infections are usually caused by strains that produce multiple resistance mechanisms, making antimicrobial treatment increasingly difficult, especially for these biofilm-associated infections. We aimed to demonstrate the higher frequency of PJIs caused by GNB. Methods We performed a retrospective observational study with adult patients with a diagnosis of knee and hip PJIs. Patients included were submitted to an exchange of total hip and knee prostheses between September 2010 and December 2016, in two brazilian hospitals. It was included only patients with microbial diagnosis performed using either sonication fluid cultures of retrieved implant and conventional tissue cultures of periprosthetic tissues. The Infectious Disease Society of America (IDSA) definition was used to establish the diagnosis of PJIs. Multidrug-resistant (MDR) organisms were defined as acquired resistance to at least one agent in three or more antimicrobial categories. Results Were included 130 adult patients with a median age of 65.5 years, in which 60% were female. Infected hip arthroplasty was more frequent than knee infections (69% vs. 31%) and 61% were classified as late infection according to Zimmerli’s classification. One hundred twenty-three microorganisms were isolated on the tissue and sonication fluid culture. Despite the Coagulase-negative Staphylococci was the predominant microorganism (35%), Gram-negative bacilli had an expressive frequency of 30% of positivity on culture. Amongst them, 23% showed resistance to carbapenens and 38% were MDR-bacteria. The predominant microorganism was Pseudomonas spp., followed by Enterobacter spp., Acinetobacter spp., Escherichia coli, Stenotrophomonas maltophilia and Klebsiella pneumoniae, Proteus spp. and Serratia marcescens. There was no statistical difference on the resistance profile of the GNB isolated on tissue and sonicate fluid culture. Conclusion We have shown an alarming high frequency of MDR-Gram-negative bacilli PJIs in two Brazilian centers, performing microbial diagnosis using sonication and tissue cultures. Disclosures All authors: No reported disclosures.

scholarly journals Same Organism, Different Phenotype - Are Phenotypic Criteria Adequate In Coagulase-Negative Staphylococcal Orthopaedic Implant-Associated Infections?

2019 ◽  
Vol 4 (1) ◽  
pp. 16-19 ◽  
Author(s):  
Staffan Tevell ◽  
Sharmin Baig ◽  
Åsa Nilsdotter-Augustinsson ◽  
Marc Stegger ◽  
Bo Söderquist
Keyword(s):  
Genome Sequencing ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Orthopaedic Implant ◽  
Whole Genome ◽  
Joint Infections ◽  
Staphylococcus Capitis ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Microbiological Criteria

Abstract. In current diagnostic criteria for implant-associated bone- and joint infections, phenotypically identical low-virulence bacteria in two intraoperative cultures are usually required. Using whole-genome sequencing, we have further characterized three phenotypically different Staphylococcus capitis isolated from one prosthetic joint infection, highlighting the challenges in defining microbiological criteria for low-virulence prosthetic joint infections.

scholarly journals Microbiological Aetiology, Epidemiology, and Clinical Profile of Prosthetic Joint Infections: Are Current Antibiotic Prophylaxis Guidelines Effective?

2012 ◽  
Vol 56 (5) ◽  
pp. 2386-2391 ◽  
Author(s):  
Trisha N. Peel ◽  
Allen C. Cheng ◽  
Kirsty L. Buising ◽  
Peter F. M. Choong
Keyword(s):  
Antibiotic Prophylaxis ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Coagulase Negative Staphylococci ◽  
Methicillin Resistant ◽  
Content Type ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Surgical Antibiotic Prophylaxis

ABSTRACTProsthetic joint infections remain a major complication of arthroplasty. At present, local and international guidelines recommend cefazolin as a surgical antibiotic prophylaxis at the time of arthroplasty. This retrospective cohort study conducted across 10 hospitals over a 3-year period (January 2006 to December 2008) investigated the epidemiology and microbiological etiology of prosthetic joint infections. There were 163 cases of prosthetic joint infection identified. From a review of the microbiological culture results, methicillin-resistantStaphylococcus aureus(MRSA) and coagulase-negative staphylococci were isolated in 45% of infections. In addition, polymicrobial infections, particularly those involving Gram-negative bacilli and enterococcal species, were common (36%). The majority (88%) of patients received cefazolin as an antibiotic prophylaxis at the time of arthroplasty. In 63% of patients in this cohort, the microorganisms subsequently obtained were not susceptible to the antibiotic prophylaxis administered. The results of this study highlight the importance of ongoing reviews of the local ecology of prosthetic joint infection, demonstrating that the spectrum of pathogens involved is broad. The results should inform empirical antibiotic therapy. This report also provokes discussion about infection control strategies, including changing surgical antibiotic prophylaxis to a combination of glycopeptide and cefazolin, to reduce the incidence of infections due to methicillin-resistant staphylococci.

scholarly journals Antibiotics in Bone Cements Used for Prosthesis Fixation: An Efficient Way to Prevent Staphylococcus aureus and Staphylococcus epidermidis Prosthetic Joint Infection

2021 ◽  
Vol 7 ◽  
Author(s):  
Andréa Cara ◽  
Mathilde Ballet ◽  
Claire Hemery ◽  
Tristan Ferry ◽  
Frédéric Laurent ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Staphylococcus Epidermidis ◽  
Biofilm Formation ◽  
Joint Infection ◽  
Bone Cements ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Prosthesis Fixation

Prosthetic joint infections (PJIs) are one of the most frequent reasons for arthroplasty revision. These infections are mostly associated with the formation of biofilm, notably by staphylococci, such as Staphylococcus aureus and Staphylococcus epidermidis. To minimize the rates of PJIs following primary or revision total joint arthroplasty, antibiotic-loaded bone cements (ALBCs) can be used for prosthesis fixation. However, its use is still debated. Indeed, various studies reported opposite results. In this context, we aimed to compare the prophylactic anti-biofilm activity of ALBCs loaded with two antibiotics with ALBC loaded with only one antibiotic. We compared commercial ready-to-use cements containing gentamicin alone, gentamicin plus vancomycin, and gentamicin plus clindamycin to plain cement (no antibiotic), investigating staphylococcal biofilm formation for 10 strains of S. aureus and S. epidermidis with specific resistance to gentamicin, vancomycin, or clindamycin. Firstly, we performed disk diffusion assays with the elution solutions. We reported that only the cement containing gentamicin and clindamycin was able to inhibit bacterial growth at Day 9, whereas cements with gentamicin only or gentamicin and vancomycin lost their antibacterial activity at Day 3. Then, we observed that all the tested ALBCs can inhibit biofilm formation by methicillin-susceptible staphylococci without other antibiotic resistance ability. Similar results were observed when we tested vancomycin-resistant or clindamycin-resistant staphylococci, with some strain-dependent significant increase of efficacy for the two antibiotic ALBCs when compared with gentamicin-loaded cement. However, adding vancomycin or clindamycin to gentamicin allows a better inhibition of biofilm formation when gentamicin-resistant strains were used. Our in vitro results suggest that using commercially available bone cements loaded with gentamicin plus vancomycin or clindamycin for prosthesis fixation can help in preventing staphylococcal PJIs following primary arthroplasties, non-septic revisions or septic revisions, especially to prevent PJIs caused by gentamicin-resistant staphylococci.

Sign in / Sign up

Export Citation Format

Share Document