Microbiological and Molecular Features Associated with Persistent and Relapsing Staphylococcus aureus Prosthetic Joint Infection

Abstract

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.

Staphylococcus aureus Genomic Analysis and Outcomes in Patients with Bone and Joint Infections: A Systematic Review

“…The third study, using the analysis of WGS data did not show any differences between genome analysis and outcomes in patients with PJI [ 33 ].…”

“…Five studies reported outcomes of severity of infection [ 25 , 27 ] or determinants of chronic infection [ 24 , 31 , 36 ], whereas nine other studies used different definitions of outcome for failure, recurrence, or success [ 26 , 28 , 29 , 30 , 32 , 33 , 34 , 35 , 37 ] ( Table 2 ).…”

“…In six studies of only PJI [ 27 , 28 , 29 , 30 , 32 , 33 ], inclusion criteria varied, with one study including acute PJI (without precise definition) [ 27 ] and one study including only PJI with DAIR treatment [ 33 ]. In four other studies, classification of PJI varied and the rate of DAIR treatment ranged from 53% to 83% [ 28 , 29 , 30 , 32 ].…”

“…Antimicrobial therapy, specifically rifampicin use, was reported in only three studies [ 28 , 29 , 30 ], but in one study data on S. aureus and S. epidermidis were not distinguished [ 29 ]. In the six studies of PJI, the rate of failure varied from 36 to 56% [ 27 , 28 , 29 , 30 , 32 , 33 ]. Adjusting analysis on confounding factors was performed in only one study [ 30 ].…”

“…Six studies comparing initial and relapse S. aureus strains in BJI after treatment failure were included: 3 case reports (with one patient) [ 38 , 39 , 40 ], and 3 case series with 3, 4 and 14 patients, respectively [ 33 , 41 , 42 ] ( Table 3 ). Three studies analyzed only patients with PJI [ 33 , 40 , 41 ] and one study included OM with foreign bodies in one patient and PJI in two patients [ 42 ]. Two other studies included OM and native septic arthritis [ 38 , 39 ].…”