Small-colony variant of Staphylococcus lugdunensis in prosthetic joint infection

Askar, Mohamed; Bloch, Benjamin V.; Bayston, Roger

doi:10.1016/j.artd.2018.06.003

Cited by 12 publications

(18 citation statements)

References 31 publications

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“…Globally, three types of physiopathological mechanisms, depending of the studied species, can be involved in staphylococcal chronic PJI: formation of small colony variants (SCV) (see the review from Proctor et al, 2014), bacterial internalization in osteoblasts (Josse et al, 2015), and formation of biofilm (Paharik and Horswill, 2016). For SCV formation, it has been observed for S. aureus , S. epidermidis , and S. lugdunensis (Proctor et al, 1994; von Eiff et al, 1999; Askar et al, 2018). SCV get a slow metabolism that makes them more tolerant to antibiotics.…”

Section: Staphylococcal Biofilmmentioning

confidence: 94%

Interaction Between Staphylococcal Biofilm and Bone: How Does the Presence of Biofilm Promote Prosthesis Loosening?

et al. 2019

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With the aging of population, the number of indications for total joint replacement is continuously increasing. However, prosthesis loosening can happen and is related to two major mechanisms: (1) aseptic loosening due to prosthesis micromotion and/or corrosion and release of wear particles from the different components of the implanted material and (2) septic loosening due to chronic prosthetic joint infection (PJI). The “aseptic” character of prosthesis loosening has been challenged over the years, especially considering that bacteria can persist in biofilms and be overlooked during diagnosis. Histological studies on periprosthetic tissue samples reported that macrophages are the principle cells associated with aseptic loosening due to wear debris. They produce cytokines and favor an inflammatory environment that induces formation and activation of osteoclasts, leading to bone resorption and periprosthetic osteolysis. In PJIs, the presence of infiltrates of polymorphonuclear neutrophils is a major criterion for histological diagnosis. Neutrophils are colocalized with osteoclasts and zones of osteolysis. A similar inflammatory environment also develops, leading to bone resorption through osteoclasts. Staphylococcus aureus , Staphylococcus epidermidis , and Staphylococcus lugdunensis are the main staphylococci observed in PJIs. They share the common feature to form biofilm. For S. aureus and S. epidermidis , the interaction between biofilm and immunes cells (macrophages and polymorphonuclear neutrophils) differs regarding the species. Indeed, the composition of extracellular matrix of biofilm seems to impact the interaction with immune cells. Recent papers also reported the major role of myeloid-derived suppressor cells in biofilm-associated PJIs with S. aureus . These cells prevent lymphocyte infiltration and facilitate biofilm persistence. Moreover, the role of T lymphocytes is still unclear and potentially underestimates. In this review, after introducing the cellular mechanism of aseptic and septic loosening, we will focus on the interrelationships between staphylococcal biofilm, immune cells, and bone cells.

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Section: Staphylococcal Biofilmmentioning

confidence: 94%

Interaction Between Staphylococcal Biofilm and Bone: How Does the Presence of Biofilm Promote Prosthesis Loosening?

et al. 2019

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“…Hemin and menadione auxotrophy in clinical CoNS SCVs has been reported by several authors, and it has been correlated with aminoglycoside resistance in the majority of isolates [29,31,32,34,36].…”

Section: Mechanisms Underlying the Selection Of Scvsmentioning

confidence: 77%

“…Thymidinedependent SCVs can survive only in the presence of exogenous thymidine provided in infected tissues due to the cell degradation and the presence of pus since they carry mutations in the thyA gen [6]. To the best of the knowledge of the authors of this publication, there has been only one report of a clinical S. epidermidis SCV from PJI with thymidine dependence detected [29].…”

Section: Mechanisms Underlying the Selection Of Scvsmentioning

confidence: 96%

“…In the latter group, staphylococcal SCVs including those represented by CoNS are observed with high regularity. The majority of studies reporting the isolation of CoNS SCVs from clinical infections have been associated with medical device-associated infections [28][29][30][31][32][33][34][35][36]. Tande et al [31], for example, investigated clinical characteristics and outcomes of PJIs caused by SCV staphylococci and revealed that subjects with SCVs were more likely to have received prior surgical and chronic antimicrobial therapy for their infection.…”

Section: How Does the Scv Phenotype Arise?mentioning

confidence: 99%

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The road to success of coagulase-negative staphylococci: clinical significance of small colony variants and their pathogenic role in persistent infections

Bogut

Magryś

2021

Eur J Clin Microbiol Infect Dis

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Bacterial small colony variants represent an important aspect of bacterial variability. They are naturally occurring microbial subpopulations with distinctive phenotypic and pathogenic traits, reported for many clinically important bacteria. In clinical terms, SCVs tend to be associated with persistence in host cells and tissues and are less susceptible to antibiotics than their wild-type (WT) counterparts. The increased tendency of SCVs to reside intracellularly where they are protected against the host immune responses and antimicrobial drugs is one of the crucial aspects linking SCVs to recurrent or chronic infections, which are difficult to treat. An important aspect of the SCV ability to persist in the host is the quiescent metabolic state, reduced immune response and expression a changed pattern of virulence factors, including a reduced expression of exotoxins and an increased expression of adhesins facilitating host cell uptake. The purpose of this review is to describe in greater detail the currently available data regarding CoNS SCV and, in particular, their clinical significance and possible mechanisms by which SCVs contribute to the pathogenesis of the chronic infections. It should be emphasized that in spite of an increasing clinical significance of this group of staphylococci, the number of studies unraveling the mechanisms of CoNS SCVs formation and their impact on the course of the infectious process is still scarce, lagging behind the studies on S. aureus SCVs.

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“…As Staphylococcus species are common causes of orthopedic implant-associated infection [9], improving the detection limit for Staphylococcus species in particular would improve the usability of U-ITI. The differentiation of Staphylococcus lugdunensis from other CNS would also be preferable, as this bacterium is more virulent and should be interpreted more like S. aureus than other CNS [10, 11]. Other studies have reported challenges with detection of microbes in OIAI using the U-ITI [12–15].…”

Section: Discussionmentioning

confidence: 99%

Rapid diagnostics of orthopedic implant-associated infections using Unyvero ITI implant and tissue infection application is not optimal for Staphylococcus species identification

2019

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ObjectivesThis pilot study aimed to compare the commercial Unyvero ITI multiplex PCR application (U-ITI, Curetis GmbH) with conventional culturing concerning (a) detection of pathogens, (b) time to detection of pathogens and (c) time to and quality of antibiotic treatment recommendation in diagnostics of orthopedic implant-associated infections (OIAI).Results72 tissue biopsies from 15 consecutive patients with deep OIAI infections were analyzed with conventional culturing including phenotypic antibiotic susceptibility testing and the U-ITI. U-ITI showed lower sensitivity than conventional culturing concerning detection of pathogens (73% vs 93%). 4/15 patients would have been given false negative results by U-ITI, all of which were culture-positive for Staphylococcus species. Median time to detection of pathogens was 47 h and antibiotic resistance 89 h by conventional methods compared to 13.5 h with the U-ITI. The U-ITI did not detect antibiotic resistance, whereas conventional culturing showed resistance to antibiotics covered by the U-ITI panel in 2 patients. Time to detection of pathogens was improved, but the detection limit for staphylococci was unsatisfactory. Although the time to antibiotic treatment recommendation was significantly reduced, the U-ITI would have resulted in incorrect antibiotic recommendation in 2 patients. Our data do not support use of this assay in diagnostics.

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Small-colony variant of Staphylococcus lugdunensis in prosthetic joint infection

Cited by 12 publications

References 31 publications

Interaction Between Staphylococcal Biofilm and Bone: How Does the Presence of Biofilm Promote Prosthesis Loosening?

Interaction Between Staphylococcal Biofilm and Bone: How Does the Presence of Biofilm Promote Prosthesis Loosening?

The road to success of coagulase-negative staphylococci: clinical significance of small colony variants and their pathogenic role in persistent infections

Rapid diagnostics of orthopedic implant-associated infections using Unyvero ITI implant and tissue infection application is not optimal for Staphylococcus species identification

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