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Heterogeneous glycopeptide intermediate Staphylococcus epidermidis isolated from prosthetic joint infections

S Tevell1, C Claesson, B Hellmark

  • 1Department of Infectious Diseases, Karlstad Hospital, Karlstad, Sweden, staffan.tevell@liv.se.

European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
|December 17, 2013
PubMed

Insights

Heterogeneous vancomycin-intermediate Staphylococcus epidermidis (hGISE) is common in prosthetic joint infections (PJIs). Standard susceptibility testing may not detect hGISE, potentially leading to insufficient glycopeptide treatment for MRSE infections.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Clinical Diagnostics

Background:

  • Methicillin-resistant Staphylococcus epidermidis (MRSE) is a significant pathogen in prosthetic joint infections (PJIs).
  • Vancomycin is a primary antibiotic choice for empirical treatment of staphylococcal PJIs.
  • Emerging reports of heterogeneous glycopeptide intermediate Staphylococcus aureus (hGISA) necessitate investigation into similar resistance mechanisms in S. epidermidis.

Purpose of the Study:

  • To determine the prevalence of heterogeneous glycopeptide intermediate Staphylococcus epidermidis (hGISE) in PJIs.
  • To evaluate the effectiveness of standard antimicrobial susceptibility testing in detecting hGISE.
  • To assess the implications of hGISE on glycopeptide treatment efficacy in PJIs.

Main Methods:

  • Analysis of 122 S. epidermidis isolates from 119 patients undergoing revision surgery for PJIs in Sweden (1993-2012).
  • Antimicrobial susceptibility testing against various antibiotics, including vancomycin and teicoplanin.
  • Detection of hGISE using the macromethod Etest (MME) and glycopeptide resistance detection (GRD) Etest.

Main Results:

  • No vancomycin-resistant S. epidermidis isolates were found; however, 11.5% exhibited teicoplanin resistance.
  • hGISE was prevalent, detected in 77.9% of isolates.
  • hGISE was identified even in isolates with teicoplanin Minimum Inhibitory Concentration (MIC) ≤2 mg/L, indicating limitations of standard MIC testing.
  • Multidrug resistance was significantly higher in hGISE-positive isolates (90.5%) compared to hGISE-negative isolates (59.3%).

Conclusions:

  • Heterogeneous glycopeptide intermediate S. epidermidis (hGISE) is a common finding in prosthetic joint infections.
  • Standard laboratory diagnostic methods may fail to detect hGISE, complicating treatment decisions.
  • Glycopeptide therapy may be inadequate for PJIs caused by hGISE-positive S. epidermidis, even when standard susceptibility tests indicate susceptibility.

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