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Published on: February 2, 2024
Genotypic and Phenotypic Characteristics of Staphylococcus aureus Prosthetic Joint Infections: Insight on the
Irene Muñoz-Gallego1,2, Esther Viedma1,2,3, Jaime Esteban4
1Servicio de Microbiología, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain.
Background:
Staphylococcus aureus is the leading cause of prosthetic joint infection (PJI). Beyond the antibiogram, little attention has been paid to the influence of deep microbiological characteristics on patient prognosis. Our aim was to investigate whether microbiological genotypic and phenotypic features have a significant influence on infection pathogenesis and patient outcome.
Methods:
A prospective multicenter study was performed, including all S. aureus PJIs (2016-2017). Clinical data and phenotypic (agr functionality, β-hemolysis, biofilm formation) and genotypic characteristics of the strains were collected. Biofilm susceptibility to antimicrobials was investigated (minimal biofilm eradication concentration [MBEC] assay).
Results:
Eighty-eight patients (39.8% men, age 74.7 ± 14.1 years) were included. Forty-five had early postoperative infections (EPIs), 21 had chronic infections (CPIs), and 19 had hematogenous infections (HIs). Twenty (22.7%) were caused by methicillin-resistant S. aureus. High genotypic diversity was observed, including 16 clonal complexes (CCs), with CC5 being the most frequent (30.7%). agr activity was greater in EPI than CPI (55.6% vs 28.6%; P = .041). Strains causing EPI were phenotypically and genotypically similar, regardless of symptom duration. Treatment failure (36.5%) occurred less frequently among cases treated with implant removal. In cases treated with debridement and implant retention, there were fewer failures among those who received combination therapy with rifampin. No genotypic or phenotypic characteristics predicted failure, except vancomycin minimal inhibitory concentration ≥1.5 mg/L (23.1% failure vs 3.4%; P = .044). MBEC50 was >128 mg/L for all antibiotics tested and showed no association with prognosis.
Conclusions:
S. aureus with different genotypic backgrounds is capable of causing PJI, showing slight differences in clinical presentation and pathogenesis. No major microbiological characteristics were observed to influence the outcome, including MBEC.
Insights
Microbiological features of Staphylococcus aureus causing prosthetic joint infection (PJI) showed slight differences in pathogenesis but did not predict patient outcomes. Vancomycin resistance was a rare exception, indicating potential treatment challenges.
Area of Science:
- Infectious Diseases
- Microbiology
- Orthopedic Surgery
Background:
- Staphylococcus aureus is a primary cause of prosthetic joint infection (PJI).
- Limited understanding exists regarding the impact of microbial genotypic and phenotypic traits on PJI prognosis.
- This study aimed to explore the influence of these characteristics on infection pathogenesis and patient outcomes.
Purpose of the Study:
- To investigate the association between Staphylococcus aureus genotypic and phenotypic features and the pathogenesis and outcomes of prosthetic joint infections.
- To determine if specific microbial characteristics can predict treatment success or failure in PJI patients.
Main Methods:
- A prospective multicenter study of Staphylococcus aureus PJI cases (2016-2017).
- Collected clinical data, and analyzed phenotypic (agr functionality, beta-hemolysis, biofilm formation) and genotypic strain characteristics.
- Assessed antimicrobial susceptibility of biofilms using minimal biofilm eradication concentration (MBEC) assays.
Main Results:
- Eighty-eight patients with S. aureus PJI were included; 22.7% were methicillin-resistant strains.
- High genotypic diversity was observed, with 16 clonal complexes identified.
- No genotypic or phenotypic characteristics, including MBEC, predicted treatment failure, except for a vancomycin MIC >= 1.5 mg/L.
Conclusions:
- Staphylococcus aureus strains with diverse genotypic backgrounds can cause PJI, exhibiting minor variations in clinical presentation and pathogenesis.
- Key microbiological characteristics, including biofilm susceptibility, did not significantly influence patient prognosis.
- Vancomycin minimal inhibitory concentration emerged as a potential, albeit infrequent, predictor of treatment failure.
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