Can nasal Staphylococcus aureus screening and decolonization prior to elective total joint arthroplasty reduce surgical site and prosthesis-related infections? A systematic review and meta-analysis

Zhu, Xingyang; Sun, Xiaobo; Zeng, Yuqing; Feng, Wenjun; Li, Jie; Zeng, Jianchun; Zeng, Yirong

doi:10.1186/s13018-020-01601-0

Cited by 37 publications

(32 citation statements)

References 46 publications

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“…Some studies have shown that carriers of MRSA and MRSE could be at increased risk for PJI [56]. This finding has triggered a wide range of research activities examining the efficacy of preoperative decolonization [57]. Infections at other sites (organs) distant from the joint of interest also can contribute to the development of PJI and should be eradicated before total joint arthroplasty (TJA).…”

Section: At-risk Patientsmentioning

confidence: 99%

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Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Gallo

Nieslanikova

2020

JCM

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A projected increased use of total joint arthroplasties will naturally result in a related increase in the number of prosthetic joint infections (PJIs). Suppression of the local peri-implant immune response counters efforts to eradicate bacteria, allowing the formation of biofilms and compromising preventive measures taken in the operating room. For these reasons, the prevention of PJI should focus concurrently on the following targets: (i) identifying at-risk patients; (ii) reducing “bacterial load” perioperatively; (iii) creating an antibacterial/antibiofilm environment at the site of surgery; and (iv) stimulating the local immune response. Despite considerable recent progress made in experimental and clinical research, a large discrepancy persists between proposed and clinically implemented preventative strategies. The ultimate anti-infective strategy lies in an optimal combination of all preventative approaches into a single “clinical pack”, applied rigorously in all settings involving prosthetic joint implantation. In addition, “anti-infective” implants might be a choice in patients who have an increased risk for PJI. However, further progress in the prevention of PJI is not imaginable without a close commitment to using quality improvement tools in combination with continual data mining, reflecting the efficacy of the preventative strategy in a particular clinical setting.

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Section: At-risk Patientsmentioning

confidence: 99%

“…Elimination of S. aureus (MRSA) carriers from TJA surgery could contribute to reductions in PJI [57]; however, some patients may be carriers even after decontamination [67,68].…”

Section: Staphylococcal Decolonization (Nasal Skin)mentioning

confidence: 99%

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Gallo

Nieslanikova

2020

JCM

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“…This is probably due to its high potential for metastatic infection, high affinity for foreign material, and extraordinary ability to develop antibiotic resistance [ 18 , 51 ]. The prevalence of S. aureus can also be explain by the skin and soft tissue colonization leading to infection through wounds and the hematogenous way [ 52 , 53 , 54 ]. Thus, S. aureus is the most common species causing PJIs, as recent reviews estimate its incrimination between 27% to 43.6% [ 26 , 31 ].…”

Section: Antibiotic Failure In Pji Due To S Aureus mentioning

confidence: 99%

Antibiotic Tolerance of Staphylococcus aureus Biofilm in Periprosthetic Joint Infections and Antibiofilm Strategies

et al. 2020

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The need for bone and joint prostheses is currently growing due to population aging, leading to an increase in prosthetic joint infection cases. Biofilms represent an adaptive and quite common bacterial response to several stress factors which confer an important protection to bacteria. Biofilm formation starts with bacterial adhesion on a surface, such as an orthopedic prosthesis, further reinforced by matrix synthesis. The biofilm formation and structure depend on the immediate environment of the bacteria. In the case of infection, the periprosthetic joint environment represents a particular interface between bacteria, host cells, and the implant, favoring biofilm initiation and maturation. Treating such an infection represents a huge challenge because of the biofilm-specific high tolerance to antibiotics and its ability to evade the immune system. It is crucial to understand these mechanisms in order to find new and adapted strategies to prevent and eradicate implant-associated infections. Therefore, adapted models mimicking the infectious site are of utmost importance to recreate a relevant environment in order to test potential antibiofilm molecules. In periprosthetic joint infections, Staphylococcus aureus is mainly involved because of its high adaptation to the human physiology. The current review deals with the mechanisms involved in the antibiotic resistance and tolerance of Staphylococcus aureus in the particular periprosthetic joint infection context, and exposes different strategies to manage these infections.

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“…This is particularly relevant for arthroplasty procedures, as S. aureus is a frequent cause of prosthetic joint infection (PJI) with methicillin-resistant S. aureus (MRSA) strains responsible for up to half of these infections ( 9 , 10 ). As a result, patients who are S. aureus carriers are subjected to decolonization protocols prior to arthroplasty as a standard of care at many medical institutions ( 11 , 12 ). Not only are PJIs often associated with bacteria that harbor genes that encode antibiotic resistance, but they are also typified by biofilm formation, which affords antibiotic tolerance and dampens host proinflammatory immune responses ( 1 , 13 , 14 ).…”

Section: Introductionmentioning

confidence: 99%

Staphylococcus aureus ATP Synthase Promotes Biofilm Persistence by Influencing Innate Immunity

Bosch

Bertrand

Heim

et al. 2020

mBio

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Staphylococcus aureus is a major cause of prosthetic joint infection (PJI), which is characterized by biofilm formation. S. aureus biofilm skews the host immune response toward an anti-inflammatory profile by the increased recruitment of myeloid-derived suppressor cells (MDSCs) that attenuate macrophage proinflammatory activity, leading to chronic infection. A screen of the Nebraska Transposon Mutant Library identified several hits in the ATP synthase operon that elicited a heightened inflammatory response in macrophages and MDSCs, including atpA, which encodes the alpha subunit of ATP synthase. An atpA transposon mutant (ΔatpA) had altered growth kinetics under both planktonic and biofilm conditions, along with a diffuse biofilm architecture that was permissive for leukocyte infiltration, as observed by confocal laser scanning microscopy. Coculture of MDSCs and macrophages with ΔatpA biofilm elicited significant increases in the proinflammatory cytokines interleukin 12p70 (IL-12p70), tumor necrosis factor alpha (TNF-α), and IL-6. This was attributed to increased leukocyte survival resulting from less toxin and protease production by ΔatpA biofilm as determined by liquid chromatography with tandem mass spectrometry (LC-MS/MS). The enhanced inflammatory response elicited by ΔatpA biofilm was cell lysis-dependent since it was negated by polyanethole sodium sulfanate treatment or deletion of the major autolysin, Atl. In a mouse model of PJI, ΔatpA-infected mice had decreased MDSCs concomitant with increased monocyte/macrophage infiltrates and proinflammatory cytokine production, which resulted in biofilm clearance. These studies identify S. aureus ATP synthase as an important factor in influencing the immune response during biofilm-associated infection and bacterial persistence. IMPORTANCE Medical device-associated biofilm infections are a therapeutic challenge based on their antibiotic tolerance and ability to evade immune-mediated clearance. The virulence determinants responsible for bacterial biofilm to induce a maladaptive immune response remain largely unknown. This study identified a critical role for S. aureus ATP synthase in influencing the host immune response to biofilm infection. An S. aureus ATP synthase alpha subunit mutant (ΔatpA) elicited heightened proinflammatory cytokine production by leukocytes in vitro and in vivo, which coincided with improved biofilm clearance in a mouse model of prosthetic joint infection. The ability of S. aureus ΔatpA to augment host proinflammatory responses was cell lysis-dependent, as inhibition of bacterial lysis by polyanethole sodium sulfanate or a ΔatpAΔatl biofilm did not elicit heightened cytokine production. These studies reveal a critical role for AtpA in shaping the host immune response to S. aureus biofilm.

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Can nasal Staphylococcus aureus screening and decolonization prior to elective total joint arthroplasty reduce surgical site and prosthesis-related infections? A systematic review and meta-analysis

Cited by 37 publications

References 46 publications

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Antibiotic Tolerance of Staphylococcus aureus Biofilm in Periprosthetic Joint Infections and Antibiofilm Strategies

Staphylococcus aureus ATP Synthase Promotes Biofilm Persistence by Influencing Innate Immunity

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