Antibiotic sensitivities of coagulase-negative staphylococci and <em>Staphylococcus aureus</em> in hip and knee periprosthetic joint infections: does this differ if patients meet the International Consensus Meeting Criteria?

Abstract

IntroductionCoagulase-negative staphylococci (CoNS) are the main pathogens responsible for prosthetic joint infections (PJIs). As normal inhabitants of human skin, it is often difficult to define if they are contaminants, or if they have an active role in initiating infection. This study aims to evaluate differences in CoNS organisms (Staphylococcus hominis, Staphylococcus capitis, Staphylococcus haemolyticus, Staphylococcus warneri) and Staphylococcus aureus in terms of isolation rate and antimicrobial susceptibility from patients who met the International Consensus Meeting (ICM) criteria for PJIs and those who did not.MethodsStaphylococci isolates from January 2014 to December 2015 retrieved from patients undergoing revision joint arthroplasty were classified in accordance with criteria established by the ICM of Philadelphia.ResultsAs per the consensus classification, 50 CoNS and 39 S. aureus infections were recognized as pathogens, while 16 CoNS and four S. aureus were considered as contaminants. Frequency of isolation of S. aureus was significantly higher in infected patients than in those without infection, while no significant differences were observed among CoNS. Resistance to levofloxacin, erythromycin, gentamicin trimethoprim/sulfamethoxazole, and rifampicin was significantly more frequent in S. haemolyticus than in the other species, as well as resistance to erythromycin and gentamicin in S. hominis. In comparison to S. aureus, CoNS were significantly more resistant to daptomycin and gentamicin and more susceptible to rifampicin.ConclusionCoNS, other than Staphylococcus epidermidis, are frequently isolated from PJIs, and their infective role and antimicrobial susceptibility need to be assessed on an individual patient basis. S. haemolyticus seems to emerge as responsible for PJI in a large volume of patients, and its role needs to be further investigated, also considering its pattern of resistance.

<p>Antibiotic Resistance and <em>mecA</em> Gene Characterization of Coagulase-negative <em>Staphylococci</em> Isolated from Clinical Samples in Nepal</p>

“…Several studies have identified S. epidermidis as the most commonly isolated CoNS. 22 , 25 – 29 In contrast, some studies have suggested S. capitis 30 and S. hemolyticus 10 , 31 , 32 as the most common CoNS. S. epidermidis is the most common commensal of our skin and mucosa, and contamination through the devices during medical procedures are very common.…”

Antimicrobial Activity of Non-steroidal Anti-inflammatory Drugs on Biofilm: Current Evidence and Potential for Drug Repurposing

“…According to the performed systematic search, only two studies have assessed NSAID activity against relevant pathogenic coagulase-negative staphylococci in the last 5 years ( Pereira et al, 2018 ; Abidi et al, 2019 ). These organisms are the most common causes of healthcare-associated biofilm-related infections, like catheter-related bloodstream infections and prosthetic joint infections ( De Vecchi et al, 2018 ; Hebeisen et al, 2019 ). Species like S. epidermidis , Staphylococcus haemolyticus , Staphylococcus hominis , are also important biofilm-forming microorganisms.…”

Distribution of Coagulase-Negative Staphylococci and Antibiotic Resistance

“…In recent years, the use of devices such as intravascular catheters as well as the increase in invasive manipulation in immunosuppressed patients, have been recognized as one of the important factors associated with nosocomial infections caused by bacteria (Supré et al, 2011). The frequency of CoNS infection has been increasing mainly due to bacteremia, catheter-related infections, endocarditis, and urinary tract infections; moreover, resistance to antibiotics, especially vancomycin, is a serious problem, as bacteria demonstrating severe resistance have been identified (Koksal et al, 2009;De Vecchi et al, 2018). A 2013 study for Azih et al, has reported that 105 CoNS were isolated from 79 clinical specimens, such as discharge from wounds, urine, and male genital infections, which could cause secondary infections, such as sepsis (Azih and Enabulele, 2013).…”

“…Therefore, management of established PJI requires a combination of pathogen-specific antibiotics and surgical intervention (De Vecchi et al, 2018).…”

“…These PJIs are frequently caused by CoNS; importantly, antibiotic resistance among causative pathogens of PJI has been increasing (Veltman et al, 2019). A study involving 50 CoNS and 39 S. aureus infection cases has found that the CoNS were significantly more resistant to daptomycin and gentamicin and were more susceptible to rifampicin than S. aureus (De Vecchi et al, 2018). Another study reported (Hischebeth et al, 2019).…”