Genomic characterization of beta‐haemolytic streptococci isolated from prosthetic joint infections

Abstract

Prosthetic joint infection (PJI) is an increasing concern for the medical profession, as higher numbers of arthroplasty surgeries lead to rising PJI‐related costs. Streptococcal PJIs constitute approximately 10% of PJIs, but their genetic features and characteristics remain largely unexplored. Little is known about antimicrobial resistance (AMR) rates, whether some sequence types (ST) dominate, and whether certain virulence‐associated genes are overrepresented. We used whole‐genome sequencing of Streptococcus dysgalactiae (n = 22), Streptococcus agalactiae (n = 10) and S. pyogenes (n = 1) to elicit genomic data on 33 beta‐haemolytic streptococci isolated from PJIs in Region Örebro county, Sweden. Relatedness was inferred based on single nucleotide polymorphisms in S. dysgalactiae and S. agalactiae. The genomic data were screened for virulence‐associated genes available in the Virulence Factor Database. All isolates were screened for both phenotypic and genotypic resistance. The S. dysgalactiae and S. agalactiae isolates were genetically diverse, although 32% of S. dysgalactiae isolates (n = 7) were ST20. The speS and PI‐2A genes were less represented in these isolates among virulence‐associated genes, and AMR was more frequently observed in S. agalactiae. We conclude that PJIs caused by beta‐haemolytic streptococci are not dominated by genetically similar beta‐haemolytic streptococci. There were distinct inter‐species differences in AMR between S. agalactiae and S. dysgalactiae.

Periprosthetic Joint Infection Diagnosis: A Narrative Review

“…Streptococci cause around 10-20% of PJIs, with total knee arthroplasties (TKA) and total hip arthroplasties (THA) as the most frequent source of isolation [21]. The most commonly identified streptococcal species are Streptococcus agalactiae (accounted for more than a third of streptococcal PJIs) and Streptococcus dysgalactiae, whereas viridans streptococci and Streptococcus pneumoniae are uncommon [22,23]. Comorbidities, S. agalactiae as the infecting organism, surgical care, and antibiotic therapy without rifampicin have all been linked to a worse result.…”