Distribution characteristics of Staphylococcus spp. in different phases of periprosthetic joint infection: A review

Abstract

Periprosthetic joint infection (PJI) is a devastating condition and Staphylococcus spp. are the predominant pathogens responsible, particularly coagulase-negative staphylococci (CoNS) and Staphylococcus aureus. The aim of the present systematic review was to evaluate the distribution characteristics of specific Staphylococcus spp. in different PJI phases, reveal the effect of pathogens' feature on their distribution and suggest recommendations for antibiotic treatment of Staphylococcal PJI. The present systematic review was performed using PubMed and EMBASE databases with the aim to identify existing literature that presented the spectrum of Staphylococcus spp. that occur in PJI. Once inclusion and exclusion criteria were applied, 20 cohort studies involving 3,344 cases in 3,199 patients were included. The predominant pathogen involved in PJI was indicated to be CoNS (31.2%), followed by S. aureus (28.8%). This trend was more apparent in hip replacement procedures. In addition, almost equal proportions of CoNS and S. aureus (28.6 and 30.0%, respectively) were indicated in the delayed phase. CoNS (36.6%) were the predominant identified organism in the early phase, whereas S. aureus (38.3%) occurred primarily in the late phase. In PJI caused by S. aureus, the number of cases of methicillin-sensitive Staphylococcus aureus (MSSA) was ~2.5-fold greater than that of methicillin-resistant Staphylococcus aureus (MRSA). MRSA occurred predominantly in the early phase, whereas MSSA was largely observed in the delayed and late phases. With regards to antibiotic treatment, the feature of various pathogens and the phases of PJI were the primary considerations. The present review provides useful information for clinical practice and scientific research of PJI.

Experimental model of peri-prosthetic infection of the knee caused by Staphylococcus aureus using biomaterials representative of modern TKA

“…Implant failure due to bacterial infection continues to be a devastating and costly complication associated with TKA, with treatment typically involving multiple surgical procedures and prolonged courses of antibiotic therapy (Peel et al, 2013; Tande and Patel, 2014). MSSA causes approximately 45% of PJI cases, and is 2.5 times more likely to be associated with a PJI than MRSA (Guo et al, 2017; Tande and Patel, 2014). Despite apparent antibiotic sensitivity in vitro , the ability of MSSA strains to form biofilms on orthopaedic implants in vivo continues to pose a significant challenge for treatment of delayed- and late-onset PJI.…”

“…Significant advancements to preoperative and surgical protocols and orthopaedic materials have reduced postoperative infection rates to less than 2%, however peri-prosthetic joint infection (PJI) remains the leading cause of implant failure following TKA (Springer et al, 2017; Tande and Patel, 2014). Methicillin-sensitive S taphylococcus aureus (MSSA) is the most common cause of PJI following TKA (Guo et al, 2017; Tande and Patel, 2014). Diagnosis and treatment of PJI poses a significant burden on both the patient and healthcare system, with eradication typically requiring multiple surgical interventions, prolonged hospitalisation, and aggressive and extensive antibiotic therapy (Beam and Osmon, 2018; King et al, 2018; Tande et al, 2017).…”

Novel Insights into Staphylococcus aureus Deep Bone Infections: the Involvement of Osteocytes

“…Staphylococci, in particular S. aureus and the coagulase-negative species Staphylococcus epidermidis , have been identified as the most common causative pathogens in bone infection ( 14 , 15 ). In this study, S. aureus was investigated because of its common association with bone infection and its well-characterized ability to exist in the quasi-dormant small-colony variant (SCV) lifestyle, which potentially contributes to a chronic disease state ( 16 ).…”

Staphylococcus aureus Infects Osteoclasts and Replicates Intracellularly

“…OM is predominantly divided into two broad categories: (i) acute hematogenous OM caused by bacteria seeding directly into bone from the circulation, and (ii) secondary OM originating from a contiguous source like a soft tissue infection or orthopedic implant or following open fracture (1, 5). Acute hematogenous OM is most common in children, with 85% of cases occurring in children under 17 years of age, whereas secondary OM infections are more common in older adults, especially those undergoing orthopedic surgery (5, 6), and they account for a projected cost of more than $1 billion dollars annually in the United States (7). Regardless of the type of OM, most cases are caused by Staphylococcus aureus (6, 8).…”

“…Acute hematogenous OM is most common in children, with 85% of cases occurring in children under 17 years of age, whereas secondary OM infections are more common in older adults, especially those undergoing orthopedic surgery (5, 6), and they account for a projected cost of more than $1 billion dollars annually in the United States (7). Regardless of the type of OM, most cases are caused by Staphylococcus aureus (6, 8).…”