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Molecular epidemiology of Staphylococcus epidermidis in prosthetic joint infections
Örebro University, School of Medical Sciences.ORCID iD: 0000-0003-2867-1044
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Staphylococcus epidermidis is ubiquitous in the human microbiota, but also an important pathogen in healthcare-associated infections, such as prosthetic joint infections (PJIs). In this thesis, aspects of the molecular epidemiology of S. epidermidis in PJIs were investigated with the aim of improving our understanding of the pre- and perioperative measures required to reduce the incidence of S. epidermidis PJIs.

In Paper I, S. epidermidis retrieved from air sampling in the operating field during arthroplasty was characterized by multilocus sequence typing and antibiotic susceptibility testing. No isolates belonging to sequence types (STs) 2 and 215, previously associated with PJIs, were found in the air of the operating field. During air sampling, several Staphylococcus pettenkoferi isolates were identified, and as a spin-off of Paper I, the genomic relatedness of these isolates to S. pettenkoferi isolates from blood cultures was described in Paper II.

In Paper III, genetic traits distinguishing S. epidermidis isolated from PJIs were determined using genome-wide association study accounting for population effects after whole-genome sequencing (WGS) of a population- based 10-year collection of S. epidermidis isolates from PJIs and of nasal isolates retrieved from patients scheduled for arthroplasty. Genes associated with antimicrobial agents used for prophylaxis in arthroplasty, i.e., beta-lactam antibiotics, aminoglycosides, and chlorhexidine, were associated with PJI origin. S. epidermidis from PJIs were dominated by the ST2a, ST2b, ST5, and ST215 lineages.

In Paper IV, selective agar plates were used to investigate colonization with methicillin resistant S. epidermidis (MRSE) in patients scheduled for arthroplasty. MRSE were further characterized by WGS. A subset of patients was found to harbour PJI-associated S. epidermidis lineages in their microbiota before hospitalization, but no isolates belonging to the ST2a lineage nor any rifampicin-resistant isolates were retrieved.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2019. , p. 137
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 203
Keywords [en]
Staphylococcus epidermidis, molecular epidemiology, prosthetic joint infections, whole genome sequencing, Staphylococcus pettenkoferi
National Category
General Practice Infectious Medicine
Identifiers
URN: urn:nbn:se:oru:diva-76142ISBN: 978-91-7529-309-7 (print)OAI: oai:DiVA.org:oru-76142DiVA, id: diva2:1348975
Public defence
2019-12-06, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2019-09-06 Created: 2019-09-06 Last updated: 2019-11-12Bibliographically approved
List of papers
1. Sequence types of Staphylococcus epidermidis associated with prosthetic joint infections are not present in the laminar airflow during prosthetic joint surgery
Open this publication in new window or tab >>Sequence types of Staphylococcus epidermidis associated with prosthetic joint infections are not present in the laminar airflow during prosthetic joint surgery
2015 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 123, no 7, p. 589-595Article in journal (Refereed) Published
Abstract [en]

Molecular characterization of Staphylococcus epidermidis isolates from prosthetic joint infections (PJIs) has demonstrated a predominance of healthcare-associated multi-drug resistant sequence types (ST2 and ST215). How, and when, patients acquire these nosocomial STs is not known. The aim was to investigate if sequence types of S. epidermidis associated with PJIs are found in the air during prosthetic joint surgery. Air sampling was undertaken during 17 hip/knee arthroplasties performed in operating theaters equipped with mobile laminar airflow units in a 500-bed hospital in central Sweden. Species identification was performed using MALDI-TOF MS and 16S rRNA gene analysis. Isolates identified as S. epidermidis were further characterized by MLST and antibiotic susceptibility testing. Seven hundred and thirty-five isolates were available for species identification. Micrococcus spp. (n = 303) and coagulase-negative staphylococci (n = 217) constituted the majority of the isolates. Thirty-two isolates of S. epidermidis were found. S. epidermidis isolates demonstrated a high level of allelic diversity with 18 different sequence types, but neither ST2 nor ST215 was found. Commensals with low pathogenic potential dominated among the airborne microorganisms in the operating field during prosthetic joint surgery. Nosocomial sequence types of S. epidermidis associated with PJIs were not found, and other routes of inoculation are therefore of interest in future studies.

Place, publisher, year, edition, pages
Hoboken, USA: Wiley-Blackwell, 2015
Keywords
Staphylococcus epidermidis, ST2, ST215, prosthetic joint infections, airborne transmission
National Category
Infectious Medicine Immunology in the medical area
Research subject
Immunology; Microbiology; Pathology
Identifiers
urn:nbn:se:oru:diva-44704 (URN)10.1111/apm.12392 (DOI)000356972400007 ()25951935 (PubMedID)2-s2.0-84932196136 (Scopus ID)
Note

Funding Agencies:

Örebro County Council Research Committee, Örebro Sweden

Centre for Clinical Research, Västerås

County Council of Västmanland Research Fund

Available from: 2015-05-27 Created: 2015-05-27 Last updated: 2019-11-12Bibliographically approved
2. Genomic relatedness of Staphylococcus pettenkoferi isolates of different origins
Open this publication in new window or tab >>Genomic relatedness of Staphylococcus pettenkoferi isolates of different origins
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2017 (English)In: Journal of Medical Microbiology, ISSN 0022-2615, E-ISSN 1473-5644, Vol. 66, no 5, p. 601-608Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of the study was to characterize clinical and environmental Staphylococcus pettenkoferi isolates with regard to genomic diversity and antibiotic susceptibility pattern. Repetitive-sequence-based PCR and core genome phylogenetic analysis of whole-genome sequencing (WGS) data verified the presence of distinct clades comprising closely related S. pettenkoferi isolates from different geographical locations and origins.

Methodology: Phylogenetic relationships between 25 S. pettenkoferi isolates collected from blood cultures and intra-operative air sampling were determined by repetitive-sequence-based PCR typing and analysis of similar to 157 000 SNPs identified in the core genome after WGS. Antibiotic susceptibility testing and tests for biofilm production (microtitre plate assay) were performed.

Results: Repetitive-sequence-based PCR as well as WGS data demonstrated the close relatedness of clinically significant blood culture isolates to probable contaminants, as well as to environmental isolates. Antibiotic-susceptibility testing demonstrated a low level of antimicrobial resistance. The mecA gene was present in two cefoxitin-resistant isolates. No isolates were found to produce biofilm.

Conclusion: Close genomic relatedness of S. pettenkoferi isolates from different geographical locations and origins were found within clades, but with substantial genomic difference between the two major clades. The ecological niche of S. pettenkoferi remains unconfirmed, but the presence of S. pettenkoferi in the air of the operating field favours the suggestion of a role in skin flora. Identification of S. pettenkoferi in clinical samples should, in a majority of cases, most likely be regarded as a probable contamination, and its role as a possible pathogen in immunocompromised hosts remains to be clarified.

Place, publisher, year, edition, pages
Microbiology Society, 2017
Keywords
Staphylococcus pettenkoferi, genotypic relatedness, repetitive-sequence based PCR typing, whole-genome sequencing
National Category
Microbiology in the medical area
Identifiers
urn:nbn:se:oru:diva-58000 (URN)10.1099/jmm.0.000472 (DOI)000401984900007 ()28530888 (PubMedID)2-s2.0-85019900525 (Scopus ID)
Note

Funding Agencies:

Örebro County Council Research Committee, Örebro, Sweden

Centre for Clinical Research, Västerås  

County Council of Västmanland Research Fund 

Available from: 2017-06-13 Created: 2017-06-13 Last updated: 2019-11-12Bibliographically approved
3. Genomic traits in Staphylococcus epidermidis associated with prosthetic joint infections
Open this publication in new window or tab >>Genomic traits in Staphylococcus epidermidis associated with prosthetic joint infections
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-77834 (URN)
Available from: 2019-11-12 Created: 2019-11-12 Last updated: 2019-11-12Bibliographically approved
4. Methicillin resistant Staphylococcus epidermidis lineages in the nasal and skin microbiota of patients scheduled for arthroplasty surgery
Open this publication in new window or tab >>Methicillin resistant Staphylococcus epidermidis lineages in the nasal and skin microbiota of patients scheduled for arthroplasty surgery
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-77835 (URN)
Available from: 2019-11-12 Created: 2019-11-12 Last updated: 2019-11-12Bibliographically approved

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