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Microbiological and Molecular Features Associated with Persistent and Relapsing Staphylococcus aureus Prosthetic
Irene Muñoz-Gallego1, María Ángeles Meléndez-Carmona1, Jaime Lora-Tamayo2,3
1Department of Clinical Microbiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica "i + 12" Hospital 12 de Octubre, 28041 Madrid, Spain.
Background:
Persistent and relapsing prosthetic joint infection (PJI) due to Staphylococcus aureus presents a clinical challenge. This study aimed to provide an extensive description of phenotypic and genomic changes that could be related to persistence or relapse.
Methods:
Initial and second S. aureus isolates from 6 cases of persistent and relapsing PJI, along with clinical isolates from 8 cases, with favorable outcome were included. All isolates were studied by phenotypic and genotypic approaches.
Results:
Recurrent S. aureus isolates exhibited a significant increase in adhesive capacity, invasion and persistence compared to resolved isolates. No association was found for the presence or absence of certain genes with the persistence or relapse of PJI. All sequential isolates showed identical sequence type (ST). Resistance gene loss during the infection and a great diversity of variants in different virulence genes between the pair of strains, mainly in genes encoding adhesins such as fnbA, were observed.
Conclusions:
S. aureus-caused relapse and persistence PJI is associated with bacterial phenotypical and genotypical adaptation. The main paths of adaptation were persistence in the intracellular compartment, and the loss of antibiotic resistance genes and variant acquisition, especially in genes encoding adhesins.
Insights
Staphylococcus aureus prosthetic joint infections (PJI) can persist or relapse due to bacterial adaptation. Recurrent strains show increased adhesion and invasion, with genetic changes in virulence factors like adhesins.
Area of Science:
- Microbiology
- Infectious Diseases
- Genomics
Background:
- Prosthetic joint infections (PJI) caused by Staphylococcus aureus are challenging due to persistence and relapse.
- Understanding bacterial adaptation is crucial for managing recurrent PJI.
Purpose of the Study:
- To describe phenotypic and genomic changes in Staphylococcus aureus associated with PJI persistence and relapse.
- To identify bacterial adaptation mechanisms contributing to treatment failure.
Main Methods:
- Phenotypic and genotypic analysis of Staphylococcus aureus isolates from PJI cases.
- Comparison of initial and recurrent isolates from persistent/relapsing PJI.
- Analysis of isolates from PJI cases with favorable outcomes.
Main Results:
- Recurrent S. aureus isolates showed increased adhesion, invasion, and persistence compared to resolved isolates.
- No specific genes were consistently associated with PJI persistence or relapse.
- Sequential isolates maintained the same sequence type (ST), but exhibited loss of resistance genes and variations in virulence genes, particularly adhesins (e.g., fnbA).
Conclusions:
- Staphylococcus aureus adaptation, including phenotypic and genotypic changes, drives PJI relapse and persistence.
- Key adaptation strategies involve intracellular persistence, loss of antibiotic resistance genes, and acquisition of variants in virulence genes, especially adhesins.
