Adaptive antimicrobial resistance, a description of microbial variants, and their relevance to periprosthetic joint...

Area of Science:

• Orthopedics
• Infectious Diseases
• Microbiology

Background:

• Periprosthetic joint infection (PJI) presents a significant challenge in orthopedic surgery, with current treatment protocols showing stagnant cure rates.
• Established methods like antimicrobial cement spacers and parenteral antibiotics have limitations in eradicating PJI.
• Emerging adaptive microbial resistance mechanisms complicate treatment beyond traditional antimicrobial resistance.

Purpose of the Study:

• To review known and novel adaptive resistance mechanisms employed by microbes relevant to PJI.
• To inform clinicians about these adaptive mechanisms and their impact on PJI treatment.
• To discuss the implications of microbial adaptive resistance for future PJI therapeutic strategies.

Main Methods:

• Literature review focusing on adaptive resistance mechanisms in microbes associated with PJI.
• Analysis of current treatment strategies and their limitations in the context of evolving microbial adaptations.
• Synthesis of information on both well-documented and newly identified resistance mechanisms.

Main Results:

• Microbiota have developed adaptive resistance mechanisms in response to increased antimicrobial pressure, extending beyond conventional resistance genes.
• These adaptive mechanisms represent a significant hurdle in achieving successful PJI eradication.
• Both established and novel adaptive resistance strategies employed by microbes are detailed.

Conclusions:

• Understanding microbial adaptive resistance is essential for advancing PJI treatment protocols.
• Future strategies for PJI management must account for these sophisticated microbial defense mechanisms.
• This review provides critical insights for clinicians to navigate the complexities of PJI treatment in the face of evolving antimicrobial resistance.