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Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus
Örebro University, School of Medical Sciences. Department of Orthopedics.
Örebro University, School of Medical Sciences. Department of Infectious Diseases, Karlstad, and Centre for Clinical Research, Region Värmland, Karlstad, Sweden.
Örebro University, School of Medical Sciences. Örebro University Hospital.ORCID iD: 0000-0002-1046-383x
Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
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(English)Manuscript (preprint) (Other academic)
National Category
Infectious Medicine
Identifiers
URN: urn:nbn:se:oru:diva-77473OAI: oai:DiVA.org:oru-77473DiVA, id: diva2:1362587
Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2019-10-21Bibliographically approved
In thesis
1. Staphylococcal prosthetic joint infections: similar, but still different
Open this publication in new window or tab >>Staphylococcal prosthetic joint infections: similar, but still different
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2019. p. 114
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 200
Keywords
Prosthetic joint infections, staphylococcal infections, nasal carriage, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus capitis, NRCS-A, antibiotic resistance, heterogeneous glycopeptide resistance, whole-genome sequencing
National Category
General Practice Infectious Medicine
Research subject
Infectious Diseases
Identifiers
urn:nbn:se:oru:diva-75928 (URN)978-91-7529-305-9 (ISBN)
Public defence
2019-11-15, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 10:00 (English)
Opponent
Supervisors
Available from: 2019-08-28 Created: 2019-08-28 Last updated: 2019-10-22Bibliographically approved

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Wildeman, PeterTevell, StaffanEriksson, CarlSöderquist, BoStenmark, Bianca

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