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Published on: February 2, 2024
Staphylococcus capitis isolated from prosthetic joint infections
S Tevell1,2, B Hellmark3, Å Nilsdotter-Augustinsson4
1Department of Infectious Diseases, Karlstad Hospital, Karlstad, Sweden. staffan.tevell@liv.se.
Abstract:
Further knowledge about the clinical and microbiological characteristics of prosthetic joint infections (PJIs) caused by different coagulase-negative staphylococci (CoNS) may facilitate interpretation of microbiological findings and improve treatment algorithms. Staphylococcus capitis is a CoNS with documented potential for both human disease and nosocomial spread. As data on orthopaedic infections are scarce, our aim was to describe the clinical and microbiological characteristics of PJIs caused by S. capitis. This retrospective cohort study included three centres and 21 patients with significant growth of S. capitis during revision surgery for PJI between 2005 and 2014. Clinical data were extracted and further microbiological characterisation of the S. capitis isolates was performed. Multidrug-resistant (≥3 antibiotic groups) S. capitis was detected in 28.6 % of isolates, methicillin resistance in 38.1 % and fluoroquinolone resistance in 14.3 %; no isolates were rifampin-resistant. Heterogeneous glycopeptide-intermediate resistance was detected in 38.1 %. Biofilm-forming ability was common. All episodes were either early post-interventional or chronic, and there were no haematogenous infections. Ten patients experienced monomicrobial infections. Among patients available for evaluation, 86 % of chronic infections and 70 % of early post-interventional infections achieved clinical cure; 90 % of monomicrobial infections remained infection-free. Genetic fingerprinting with repetitive sequence-based polymerase chain reaction (rep-PCR; DiversiLab®) displayed clustering of isolates, suggesting that nosocomial spread might be present. Staphylococcus capitis has the potential to cause PJIs, with infection most likely being contracted during surgery or in the early postoperative period. As S. capitis might be an emerging nosocomial pathogen, surveillance of the prevalence of PJIs caused by S. capitis could be recommended.
Insights
Staphylococcus capitis can cause prosthetic joint infections (PJIs), often acquired during surgery. This study highlights its resistance patterns and biofilm formation, suggesting it may be an emerging nosocomial pathogen.
Area of Science:
- Orthopaedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Coagulase-negative staphylococci (CoNS) are significant pathogens in prosthetic joint infections (PJIs).
- Limited data exists on the specific clinical and microbiological profiles of PJIs caused by Staphylococcus capitis.
- Staphylococcus capitis is recognized for its potential in human disease and nosocomial transmission.
Purpose of the Study:
- To delineate the clinical and microbiological characteristics of PJIs attributed to Staphylococcus capitis.
- To assess antimicrobial resistance patterns and biofilm formation in S. capitis isolates from PJI cases.
- To investigate the potential for nosocomial spread of S. capitis in the context of PJIs.
Main Methods:
- Retrospective cohort study across three centers involving 21 patients with S. capitis PJI.
- Clinical data extraction and comprehensive microbiological characterization of isolates.
- Antimicrobial susceptibility testing, including resistance to methicillin and fluoroquinolones, and biofilm formation assays.
- Genetic fingerprinting using repetitive sequence-based polymerase chain reaction (rep-PCR).
Main Results:
- Prevalence of multidrug-resistant S. capitis (28.6%), methicillin-resistant S. capitis (38.1%), and fluoroquinolone resistance (14.3%).
- High incidence of heterogeneous glycopeptide-intermediate resistance (38.1%) and common biofilm-forming ability.
- Infections were primarily early post-interventional or chronic, with high clinical cure rates (86% for chronic, 70% for early).
- Genetic analysis suggested potential nosocomial clustering of isolates.
Conclusions:
- Staphylococcus capitis is a viable pathogen capable of causing prosthetic joint infections.
- Infections are typically acquired peri-operatively, and S. capitis exhibits significant antimicrobial resistance and biofilm potential.
- The findings suggest S. capitis may be an emerging nosocomial pathogen, warranting surveillance and consideration in PJI treatment strategies.
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