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Heterogeneous glycopeptide intermediate Staphylococcus epidermidis isolated from prosthetic joint infections
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Infectious Diseases, Karlstad Hospital, Karlstad, Sweden.
Division of Clinical Microbiology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Clinical Microbiology, County Council of Östergötland, Linköping, Sweden.
Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
Örebro University, School of Medicine, Örebro University, Sweden. Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden; Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0001-5939-2932
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2014 (English)In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 33, no 6, p. 911-917Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
New York: Springer, 2014. Vol. 33, no 6, p. 911-917
National Category
Infectious Medicine Microbiology in the medical area
Research subject
Infectious Diseases; Microbiology
Identifiers
URN: urn:nbn:se:oru:diva-35350DOI: 10.1007/s10096-013-2025-3ISI: 000335743500004PubMedID: 24338092Scopus ID: 2-s2.0-84903820002OAI: oai:DiVA.org:oru-35350DiVA, id: diva2:724683
Note

Funding Agencies:

Research committee of Östergotland, County Council, Sweden

Research committee of Värmland, County Council, Sweden

Available from: 2014-06-13 Created: 2014-06-13 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)
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Available from: 2019-08-28 Created: 2019-08-28 Last updated: 2019-10-22Bibliographically approved

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Tevell, StaffanHellmark, BengtSöderquist, Bo

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