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Wildeman, P., Tevell, S., Eriksson, C., Lagos, A. C., Söderquist, B. & Stenmark, B. (2020). Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus. Scientific Reports, 10(1), Article ID 5938.
Öppna denna publikation i ny flik eller fönster >>Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus
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2020 (Engelska)Ingår i: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 10, nr 1, artikel-id 5938Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Staphylococcus aureus is a commensal colonizing the skin and mucous membranes. It can also act as a pathogen, and is the most common microorganism isolated from prosthetic joint infections (PJIs). The aim of this study was to explore the genomic relatedness between commensal and PJI S. aureus strains as well as microbial traits and host-related risk factors for treatment failure. Whole-genome sequencing (WGS) was performed on S. aureus isolates obtained from PJIs (n = 100) and control isolates from nares (n = 101). Corresponding clinical data for the PJI patients were extracted from medical records. No PJI-specific clusters were found in the WGS phylogeny, and the distribution of the various clonal complexes and prevalence of virulence genes among isolates from PJIs and nares was almost equal. Isolates from patients with treatment success and failure were genetically very similar, while the presence of an antibiotic-resistant phenotype and the use of non-biofilm-active antimicrobial treatment were both associated with failure.In conclusion, commensal and PJI isolates of S. aureus in arthroplasty patients were genetically indistinguishable, suggesting that commensal S. aureus clones are capable of causing PJIs. Furthermore, no association between genetic traits and outcome could be demonstrated, stressing the importance of patient-related factors in the treatment of S. aureus PJIs.

Ort, förlag, år, upplaga, sidor
Nature Publishing Group, 2020
Nationell ämneskategori
Infektionsmedicin
Identifikatorer
urn:nbn:se:oru:diva-81038 (URN)10.1038/s41598-020-62751-z (DOI)32246045 (PubMedID)
Tillgänglig från: 2020-04-06 Skapad: 2020-04-06 Senast uppdaterad: 2020-04-06Bibliografiskt granskad
Tevell, S., Christensson, B., Nilsdotter-Augustinsson, Å., Rydén, C., Ryding, U., Söderquist, B. & Åkerlund, B. (2019). Handläggning av infektioner vid ortopediska implantat en utmaning för vården [Treatment of orthopedic implant-associated infections]. Läkartidningen, 116(43), Article ID FR6C.
Öppna denna publikation i ny flik eller fönster >>Handläggning av infektioner vid ortopediska implantat en utmaning för vården [Treatment of orthopedic implant-associated infections]
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2019 (Svenska)Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, nr 43, artikel-id FR6CArtikel, forskningsöversikt (Refereegranskat) Published
Abstract [en]

The Swedish National Guidelines for Bone and Joint Infections were revised during 2018. The work was carried out on behalf of the Swedish Society for Infectious Diseases. The study group consists of senior consultants in infectious diseases, supported by specialists in orthopedic surgery, clinical microbiology and allergology when needed. The study group emphasizes that implant associated infections are challenging and requires multidisciplinary cooperation, including, but not limited to, specialists in orthopedic surgery, infectious diseases, clinical microbiology and radiology for optimal treatment results. All aspects of the clinical management are equally important; selecting the optimal antibiotic prophylaxis in arthroplasty as well as fracture surgery, early diagnosis of infection, adequate treatment, follow-up, and finally a structured evaluation of outcome. Profound and updated knowledge of treatment of biofilm related infection is necessary to achieve optimal results in patients with implant-associated infections. Future challenges include improved decision support for combining surgical treatment with selection of proper antibiotics, as well as management of antibiotic resistance, drug-drug interactions and adverse effects of antibiotic treatment.

Ort, förlag, år, upplaga, sidor
Läkartidningen Förlag AB, 2019
Nationell ämneskategori
Infektionsmedicin
Identifikatorer
urn:nbn:se:oru:diva-77620 (URN)31638706 (PubMedID)
Tillgänglig från: 2019-10-25 Skapad: 2019-10-25 Senast uppdaterad: 2019-10-25Bibliografiskt granskad
Tevell, S., Baig, S., Nilsdotter-Augustinsson, Å., Stegger, M. & Söderquist, B. (2019). Same Organism, Different Phenotype: Are Phenotypic Criteria Adequate In Coagulase-Negative Staphylococcal Orthopaedic Implant-Associated Infections?. Journal of bone and joint infection, 4(1), 16-19
Öppna denna publikation i ny flik eller fönster >>Same Organism, Different Phenotype: Are Phenotypic Criteria Adequate In Coagulase-Negative Staphylococcal Orthopaedic Implant-Associated Infections?
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2019 (Engelska)Ingår i: Journal of bone and joint infection, ISSN 2206-3552, Vol. 4, nr 1, s. 16-19Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

In current diagnostic criteria for implant-associated bone- and joint infections, phenotypically identical low-virulence bacteria in two intraoperative cultures are usually required. Using whole-genome sequencing, we have further characterized three phenotypically different Staphylococcus capitis isolated from one prosthetic joint infection, highlighting the challenges in defining microbiological criteria for low-virulence prosthetic joint infections.

Ort, förlag, år, upplaga, sidor
British Editorial Society of Bone and Joint Surger, 2019
Nationell ämneskategori
Infektionsmedicin
Identifikatorer
urn:nbn:se:oru:diva-77484 (URN)10.7150/jbji.30256 (DOI)30755843 (PubMedID)
Tillgänglig från: 2019-10-21 Skapad: 2019-10-21 Senast uppdaterad: 2019-10-21Bibliografiskt granskad
Tevell, S. (2019). Staphylococcal prosthetic joint infections: similar, but still different. (Doctoral dissertation). Örebro: Örebro University
Öppna denna publikation i ny flik eller fönster >>Staphylococcal prosthetic joint infections: similar, but still different
2019 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Staphylococci constitute a major part of our commensal flora but are also the most common bacteria causing prosthetic joint infections (PJIs), a dreaded complication of arthroplasty surgery. However, not all staphylococci are the same. The virulent Staphylococcus aureus has the ability to cause severe disease such as bacteremia and infective endocarditis in previously healthy people, while the coagulase-negative staphylococci Staphylococcus epidermidis and Staphylococcus capitis rarely act as pathogens unless the patient is immunocompromised or has an implanted medical device, such as a prosthetic joint. This thesis accordingly explores similarities and differences between these three staphylococci in PJIs.

S. capitis can cause early postinterventional and chronic PJIs, a finding that has not previously been described. Furthermore, its nosocomial NRCS-A outbreak sublineage, recently observed in neonatal intensive care units, is also present in adult PJIs. When comparing nasal and PJI isolates, the patterns differed between staphylococcal species. In S. capitis, the commensal and infecting strains were separated phylogenetically, while they clustered together for S. aureus. This may indicate diverse reservoirs and acquisition routes in PJIs caused by different staphylococcal species.

Outcomes in early postinterventional PJIs were similar in S. capitis and S. aureus infections, with 70–80% achieving clinical cure. In S. aureus infections, no virulence genes were significantly associated with outcome. Although multidrug resistance (MDR) was rare in S. aureus, inability to use biofilm-active antibiotics was a risk factor for failure. However, in S. epidermidis and in the NRCS-A sublineage of S. capitis, MDR and glycopeptide heteroresistance were widespread, highlighting the challenge of antibiotic resistance in the treatment of PJIs.

Ort, förlag, år, upplaga, sidor
Örebro: Örebro University, 2019. s. 114
Serie
Örebro Studies in Medicine, ISSN 1652-4063 ; 200
Nyckelord
Prosthetic joint infections, staphylococcal infections, nasal carriage, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus capitis, NRCS-A, antibiotic resistance, heterogeneous glycopeptide resistance, whole-genome sequencing
Nationell ämneskategori
Allmänmedicin Infektionsmedicin
Forskningsämne
Infektionssjukdomar
Identifikatorer
urn:nbn:se:oru:diva-75928 (URN)978-91-7529-305-9 (ISBN)
Disputation
2019-11-15, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 10:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2019-08-28 Skapad: 2019-08-28 Senast uppdaterad: 2019-10-22Bibliografiskt granskad
Salih, L., Tevell, S., Månsson, E., Nilsdotter-Augustinsson, Å., Hellmark, B. & Söderquist, B. (2018). Staphylococcus epidermidis isolates from nares and prosthetic joint infections are mupirocin susceptible. Journal of bone and joint infection, 3(1), 1-4
Öppna denna publikation i ny flik eller fönster >>Staphylococcus epidermidis isolates from nares and prosthetic joint infections are mupirocin susceptible
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2018 (Engelska)Ingår i: Journal of bone and joint infection, ISSN 2206-3552, Vol. 3, nr 1, s. 1-4Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The objective of the present study was to investigate the antibiotic susceptibility including mupirocin among Staphylococcus. epidermidis isolated from prosthetic joint infections (PJIs) (n=183) and nasal isolates (n=75) from patients intended to undergo prosthetic joint replacements. Susceptibility to mupirocin (used for eradication of nasal carriership of Staphylococcus aureus) was investigated by gradient test, and susceptibility to various other antimicrobial agents was investigated by disc diffusion test. All isolates, except three from PJIs and one from the nares, were fully susceptible to mupirocin. Multi-drug resistance (≥3 antibiotic classes) was found in 154/183 (84.2%) of the PJI isolates but only in 2/75 (2.7%) of the nares isolates, indicating that S. epidermidis causing PJIs do not originate from the nares.

Ort, förlag, år, upplaga, sidor
Ivyspring International Publisher, 2018
Nyckelord
Antibiotic susceptibility testing, Mupirocin, Prosthetic joint infections, Staphylococcus epidermidis
Nationell ämneskategori
Infektionsmedicin
Identifikatorer
urn:nbn:se:oru:diva-64047 (URN)10.7150/jbji.22459 (DOI)29291157 (PubMedID)
Tillgänglig från: 2018-01-12 Skapad: 2018-01-12 Senast uppdaterad: 2018-09-07Bibliografiskt granskad
Tevell, S., Hellmark, B., Nilsdotter-Augustinsson, Å. & Söderquist, B. (2017). Staphylococcus capitis isolated from prosthetic joint infections. European Journal of Clinical Microbiology and Infectious Diseases, 36(1), 115-122
Öppna denna publikation i ny flik eller fönster >>Staphylococcus capitis isolated from prosthetic joint infections
2017 (Engelska)Ingår i: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 36, nr 1, s. 115-122Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Further knowledge about the clinical and microbiological characteristics of prosthetic joint infections (PJIs) caused by different coagulase-negative staphylococci (CoNS) may facilitate interpretation of microbiological findings and improve treatment algorithms. Staphylococcus capitis is a CoNS with documented potential for both human disease and nosocomial spread. As data on orthopaedic infections are scarce, our aim was to describe the clinical and microbiological characteristics of PJIs caused by S. capitis. This retrospective cohort study included three centres and 21 patients with significant growth of S. capitis during revision surgery for PJI between 2005 and 2014. Clinical data were extracted and further microbiological characterisation of the S. capitis isolates was performed. Multidrug-resistant (≥3 antibiotic groups) S. capitis was detected in 28.6 % of isolates, methicillin resistance in 38.1 % and fluoroquinolone resistance in 14.3 %; no isolates were rifampin-resistant. Heterogeneous glycopeptide-intermediate resistance was detected in 38.1 %. Biofilm-forming ability was common. All episodes were either early post-interventional or chronic, and there were no haematogenous infections. Ten patients experienced monomicrobial infections. Among patients available for evaluation, 86 % of chronic infections and 70 % of early post-interventional infections achieved clinical cure; 90 % of monomicrobial infections remained infection-free. Genetic fingerprinting with repetitive sequence-based polymerase chain reaction (rep-PCR; DiversiLab®) displayed clustering of isolates, suggesting that nosocomial spread might be present. Staphylococcus capitis has the potential to cause PJIs, with infection most likely being contracted during surgery or in the early postoperative period. As S. capitis might be an emerging nosocomial pathogen, surveillance of the prevalence of PJIs caused by S. capitis could be recommended.

Ort, förlag, år, upplaga, sidor
New York: Springer, 2017
Nationell ämneskategori
Infektionsmedicin Mikrobiologi
Identifikatorer
urn:nbn:se:oru:diva-52726 (URN)10.1007/s10096-016-2777-7 (DOI)000391388800014 ()27680718 (PubMedID)2-s2.0-84988919555 (Scopus ID)
Anmärkning

Funding Agencies:

Research committee of Värmland County Council, Sweden LIVFOU-456821  LIVFOU-457061

Research committee of Östergötland County Council, Sweden LIO-447091

Örebro University, Sweden ORU 1.3.1-01273/2015

Tillgänglig från: 2016-10-04 Skapad: 2016-10-03 Senast uppdaterad: 2019-10-21Bibliografiskt granskad
Tevell, S., Claesson, C., Hellmark, B., Söderquist, B. & Nilsdotter-Augustinsson, Å. (2014). Heterogeneous glycopeptide intermediate Staphylococcus epidermidis isolated from prosthetic joint infections. European Journal of Clinical Microbiology and Infectious Diseases, 33(6), 911-917
Öppna denna publikation i ny flik eller fönster >>Heterogeneous glycopeptide intermediate Staphylococcus epidermidis isolated from prosthetic joint infections
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2014 (Engelska)Ingår i: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 33, nr 6, s. 911-917Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Methicillin-resistant Staphylococcus epidermidis (MRSE) poses a major problem in prosthetic joint infections (PJIs). Vancomycin is often considered the drug of choice in the empirical treatment of staphylococcal PJIs. As recent decades have seen reports of heterogeneous glycopeptide intermediate S. aureus (hGISA), our aim was to examine the prevalence of heterogeneous glycopeptide intermediate S. epidermidis (hGISE) in PJIs. S. epidermidis isolates (n = 122) from 119 patients in three Swedish counties between 1993 and 2012 were included. All were isolated from perioperative tissue samples from revision surgery in clinically verified PJIs. Antimicrobial susceptibility testing against staphylococcal antibiotics was performed. The macromethod Etest (MME) and glycopeptide resistance detection (GRD) Etest were used to detect hGISE. Standard minimal inhibitory concentration (MIC) determination revealed no vancomycin-resistant isolates, while teicoplanin resistance was detected in 14 out of 122 isolates (11.5 %). hGISE was found in 95 out of 122 isolates (77.9 %), 64 out of 67 of isolates with teicoplanin MIC > 2 mg/L (95.5 %) and 31 out of 55 of isolates with teicoplanin MIC a parts per thousand currency sign2 mg/L (56.4 %). Thus, the presence of hGISE cannot be ruled out by teicoplanin MIC a parts per thousand currency sign2 mg/L alone. Multidrug resistance was detected in 86 out of 95 hGISE isolates (90.5 %) and in 16 out of 27 isolates (59.3 %), where hGISE could not be detected. In conclusion, hGISE detected by MME or GRD was common in this material. However, hGISE is difficult to detect with standard laboratory diagnostic routines. Glycopeptide treatment may not be sufficient in many of these PJIs, even if standard MIC classifies the isolated S. epidermidis as susceptible.

Ort, förlag, år, upplaga, sidor
New York: Springer, 2014
Nationell ämneskategori
Infektionsmedicin Mikrobiologi inom det medicinska området
Forskningsämne
Infektionssjukdomar; Mikrobiologi
Identifikatorer
urn:nbn:se:oru:diva-35350 (URN)10.1007/s10096-013-2025-3 (DOI)000335743500004 ()24338092 (PubMedID)2-s2.0-84903820002 (Scopus ID)
Anmärkning

Funding Agencies:

Research committee of Östergotland, County Council, Sweden

Research committee of Värmland, County Council, Sweden

Tillgänglig från: 2014-06-13 Skapad: 2014-06-13 Senast uppdaterad: 2019-10-21Bibliografiskt granskad
Wildeman, P., Tevell, S., Eriksson, C., Campillay Lagos, A., Söderquist, B. & Stenmark, B.Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus.
Öppna denna publikation i ny flik eller fönster >>Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus
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(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Nationell ämneskategori
Infektionsmedicin
Identifikatorer
urn:nbn:se:oru:diva-77473 (URN)
Tillgänglig från: 2019-10-21 Skapad: 2019-10-21 Senast uppdaterad: 2019-10-21Bibliografiskt granskad
Månsson, E., Tevell, S., Nilsdotter-Augustinsson, Å., Stegger, M. & Söderquist, B.Methicillin resistant Staphylococcus epidermidis lineages in the nasal and skin microbiota of patients scheduled for arthroplasty surgery.
Öppna denna publikation i ny flik eller fönster >>Methicillin resistant Staphylococcus epidermidis lineages in the nasal and skin microbiota of patients scheduled for arthroplasty surgery
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(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Nationell ämneskategori
Allmänmedicin
Identifikatorer
urn:nbn:se:oru:diva-77835 (URN)
Tillgänglig från: 2019-11-12 Skapad: 2019-11-12 Senast uppdaterad: 2019-11-12Bibliografiskt granskad
Tevell, S., Baig, S., Hellmark, B., Martins-Simoes, P., Wirth, T., Butin, M., . . . Stegger, M.Presence of the neonatal Staphylococcus capitis outbreak clone (NRCS-A) in prosthetic joint infections.
Öppna denna publikation i ny flik eller fönster >>Presence of the neonatal Staphylococcus capitis outbreak clone (NRCS-A) in prosthetic joint infections
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(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Nationell ämneskategori
Infektionsmedicin
Identifikatorer
urn:nbn:se:oru:diva-77474 (URN)
Tillgänglig från: 2019-10-21 Skapad: 2019-10-21 Senast uppdaterad: 2019-10-21Bibliografiskt granskad
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