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  • 1.
    Månsson, Emeli
    et al.
    Örebro University, School of Medical Sciences. Region Västmanland – Uppsala University, Centre for Clinical Research, Hospital of Västmanland, Västerås, Västerås, Sweden..
    Tevell, Staffan
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Karlstad Hospital and Centre for Clinical Research, County Countil of Värmland, Karlstad, Sweden.
    Nilsdotter-Augustinsson, Åsa
    Department of Infectious Diseases, and Department of Clinical and Experimental Medicine, Linköping University, Norrköping, Sweden.
    Stegger, Marc
    Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark.
    Söderquist, Bo
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine, Clinical Microbiology.
    Methicillin resistant Staphylococcus epidermidis lineages in the nasal and skin microbiota of patients scheduled for arthroplasty surgeryManuscript (preprint) (Other academic)
  • 2.
    Salih, Lavin
    et al.
    School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Tevell, Staffan
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Karlstad Hospital, Karlstad, Sweden.
    Månsson, Emeli
    Örebro University, School of Medical Sciences. Centre for Clinical Research, Hospital of Västmanland, Region Västmanland, Västerås, Sweden; Centre for Clinical Research, Hospital of Västmanland, Uppsala University, Västerås, Sweden.
    Nilsdotter-Augustinsson, Åsa
    Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Infectious Diseases, County Council of Östergötland, Linköping, Sweden.
    Hellmark, Bengt
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Söderquist, Bo
    Örebro University, School of Medical Sciences.
    Staphylococcus epidermidis isolates from nares and prosthetic joint infections are mupirocin susceptible2018In: Journal of bone and joint infection, ISSN 2206-3552, Vol. 3, no 1, p. 1-4Article in journal (Refereed)
    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.

  • 3.
    Tevell, Staffan
    Örebro University, School of Medical Sciences.
    Staphylococcal prosthetic joint infections: similar, but still different2019Doctoral 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.

    List of papers
    1. Heterogeneous glycopeptide intermediate Staphylococcus epidermidis isolated from prosthetic joint infections
    Open this publication in new window or tab >>Heterogeneous glycopeptide intermediate Staphylococcus epidermidis isolated from prosthetic joint infections
    Show others...
    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
    National Category
    Infectious Medicine Microbiology in the medical area
    Research subject
    Infectious Diseases; Microbiology
    Identifiers
    urn:nbn:se:oru:diva-35350 (URN)10.1007/s10096-013-2025-3 (DOI)000335743500004 ()24338092 (PubMedID)2-s2.0-84903820002 (Scopus ID)
    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
    2. Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus
    Open this publication in new window or tab >>Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Infectious Medicine
    Identifiers
    urn:nbn:se:oru:diva-77473 (URN)
    Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2019-10-21Bibliographically approved
    3. Staphylococcus capitis isolated from prosthetic joint infections
    Open this publication in new window or tab >>Staphylococcus capitis isolated from prosthetic joint infections
    2017 (English)In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 36, no 1, p. 115-122Article in journal (Refereed) 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.

    Place, publisher, year, edition, pages
    New York: Springer, 2017
    National Category
    Infectious Medicine Microbiology
    Identifiers
    urn:nbn:se:oru:diva-52726 (URN)10.1007/s10096-016-2777-7 (DOI)000391388800014 ()27680718 (PubMedID)2-s2.0-84988919555 (Scopus ID)
    Note

    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

    Available from: 2016-10-04 Created: 2016-10-03 Last updated: 2019-10-21Bibliographically approved
    4. Presence of the neonatal Staphylococcus capitis outbreak clone (NRCS-A) in prosthetic joint infections
    Open this publication in new window or tab >>Presence of the neonatal Staphylococcus capitis outbreak clone (NRCS-A) in prosthetic joint infections
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Infectious Medicine
    Identifiers
    urn:nbn:se:oru:diva-77474 (URN)
    Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2019-10-21Bibliographically approved
    5. Same Organism, Different Phenotype: Are Phenotypic Criteria Adequate In Coagulase-Negative Staphylococcal Orthopaedic Implant-Associated Infections?
    Open this publication in new window or tab >>Same Organism, Different Phenotype: Are Phenotypic Criteria Adequate In Coagulase-Negative Staphylococcal Orthopaedic Implant-Associated Infections?
    Show others...
    2019 (English)In: Journal of bone and joint infection, ISSN 2206-3552, Vol. 4, no 1, p. 16-19Article in journal (Refereed) 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.

    Place, publisher, year, edition, pages
    British Editorial Society of Bone and Joint Surger, 2019
    National Category
    Infectious Medicine
    Identifiers
    urn:nbn:se:oru:diva-77484 (URN)10.7150/jbji.30256 (DOI)30755843 (PubMedID)
    Available from: 2019-10-21 Created: 2019-10-21 Last updated: 2019-10-21Bibliographically approved
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  • 4.
    Tevell, Staffan
    et al.
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Karlstad Hospital and Centre for Clinical Research, Värmland County Council, Karlstad, Sweden.
    Baig, Sharmin
    Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark.
    Hellmark, Bengt
    Örebro University, School of Health Sciences. Department of Laboratory Medicine.
    Martins-Simoes, Patricia
    Institute for Infectious Agents, Department of Bacteriology, National Reference Center for Staphylococci, Hospices Civils de Lyon, Lyon, France; Centre International de Référence en Infectiologie INSERM U1111 CNRS UMR 5308 ENS University of Lyon, Lyon, France.
    Wirth, Thierry
    Institut de Systématique, Evolution, Biodiversité (ISYEB), UNR-CNRS 7205, Muséum National d’Histoire Naturelle, CNRS, Sorbonne Université, EPHE, Paris, France; cole Pratique des Hautes Études, PSL Université, Paris, France.
    Butin, Marine
    Centre International de Référence en Infectiologie INSERM U1111 CNRS UMR 5308 ENS University of Lyon, Lyon, France; Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France.
    Nilsdotter-Augustinsson, Åsa
    Department of Infectious Diseases and Department of Clinical and Experimental Medicine, Linköping University, Norrköping, Sweden.
    Söderquist, Bo
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine.
    Stegger, Marc
    Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark.
    Presence of the neonatal Staphylococcus capitis outbreak clone (NRCS-A) in prosthetic joint infectionsManuscript (preprint) (Other academic)
  • 5.
    Tevell, Staffan
    et al.
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Karlstad, and Centre for Clinical Research, County Council of Värmland, Sweden.
    Baig, Sharmin
    Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark.
    Nilsdotter-Augustinsson, Åsa
    Department of Infectious Diseases and Department of Clinical and Experimental Medicine, Linköping University, Norrköping, Sweden.
    Stegger, Marc
    Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark.
    Söderquist, Bo
    Örebro University, School of Medical Sciences.
    Same Organism, Different Phenotype: Are Phenotypic Criteria Adequate In Coagulase-Negative Staphylococcal Orthopaedic Implant-Associated Infections?2019In: Journal of bone and joint infection, ISSN 2206-3552, Vol. 4, no 1, p. 16-19Article in journal (Refereed)
    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.

  • 6.
    Tevell, Staffan
    et al.
    Örebro University, School of Medical Sciences. Centrum för klinisk forskning, Region Värmland, Sverige; Infektionskliniken, Karlstad, Sverige.
    Christensson, Bertil
    Avdelningen för infektionsmedicin, Lunds universitet, Lund, Sverige.
    Nilsdotter-Augustinsson, Åsa
    Infektionskliniken, Region Östergötland, Sverige; Vrinnevisjukhuset, Norrköping, Sverige.
    Rydén, Cecilia
    Infektionskliniken, Helsingborgs sjukhus, Helsingborg, Sverige.
    Ryding, Ulf
    Infektionskliniken, Östersunds sjukhus, Östersund, Sverige.
    Söderquist, Bo
    Örebro University, School of Medical Sciences. Infektionskliniken, Universitetssjukhuset Örebro, Örebro, Sverige.
    Åkerlund, Börje
    Institutionen för medicin, enheten för infektionssjukdomar, Karolinska universitetssjukhuset, Huddinge/Stockholm, Sverige.
    Handläggning av infektioner vid ortopediska implantat en utmaning för vården [Treatment of orthopedic implant-associated infections]2019In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, no 43, article id FR6CArticle, review/survey (Refereed)
    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.

  • 7.
    Tevell, Staffan
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Infectious Diseases, Karlstad Hospital, Karlstad, Sweden.
    Claesson, C.
    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.
    Hellmark, Bengt
    Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Söderquist, Bo
    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.
    Nilsdotter-Augustinsson, Å.
    Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Infectious Diseases, County Council of Östergötland, Linköping, Sweden.
    Heterogeneous glycopeptide intermediate Staphylococcus epidermidis isolated from prosthetic joint infections2014In: 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)
    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.

  • 8.
    Tevell, Staffan
    et al.
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Karlstad Hospital, Karlstad, Sweden.
    Hellmark, Bengt
    Örebro University, School of Health Sciences. Department of Laboratory Medicine.
    Nilsdotter-Augustinsson, Å.
    Department of Infectious Diseases, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Söderquist, Bo
    Örebro University, School of Medical Sciences.
    Staphylococcus capitis isolated from prosthetic joint infections2017In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 36, no 1, p. 115-122Article in journal (Refereed)
    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.

  • 9.
    Wildeman, Peter
    et al.
    Örebro University, School of Medical Sciences. Department of Orthopedics.
    Tevell, Staffan
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Karlstad, and Centre for Clinical Research, Region Värmland, Karlstad, Sweden.
    Eriksson, Carl
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Campillay Lagos, Amaya
    Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Söderquist, Bo
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine.
    Stenmark, Bianca
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Laboratory Medicine.
    Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureusManuscript (preprint) (Other academic)
  • 10.
    Wildeman, Peter
    et al.
    Örebro University, School of Medical Sciences. Department of Orthopedics.
    Tevell, Staffan
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Karlstad, and Centre for Clinical Research, Region Värmland, Karlstad, Sweden..
    Eriksson, Carl
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Lagos, Amaya Campillay
    Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Söderquist, Bo
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine.
    Stenmark, Bianca
    Örebro University, School of Medical Sciences.
    Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus2020In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 10, no 1, article id 5938Article in journal (Refereed)
    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.

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