Genotypic and Phenotypic Characteristics of Staphylococcus aureus Prosthetic Joint Infections: Insight on the Pathogenesis and Prognosis of a Multicenter Prospective Cohort
Irene Muñoz‐Gallego, Esther Viedma, Jaime Esteban, Mikel Mancheño‐Losa, Joaquín García-Cañete, Antonio Blanco-García, Alicia Rico, Adelaida García-Perea, Patricia Ruíz Garbajosa, Rosa Escudero-Sánchez, M. Sánchez Somolinos, Mercedes Marín Arriaza, Juan Romanyk, José María Barbero, Ana Arribi Vilela, Fernando González Romo, Conchita Pérez-Jorge, David M. Arana, A Monereo, Diego Domingo, José Cordero‐Ampuero, Ma Isabel Sánchez Romero, Miguel Ángel García Viejo, Jaime Lora‐Tamayo, Fernando Cháves, Grupo de Infección Osteoarticular de la Comunidad de Madrid, Raúl Parrón Cambero, Álvaro Auñón Rubio, Ricardo Fernández Roblas, Luís Alcalá, J. Marco Martínez, Berta Laguna Fonseca, J. Cacho, Gloria Pérez Caballero
Abstract
Abstract Background Staphylococcus aureus is the leading cause of prosthetic joint infection (PJI). Beyond the antibiogram, little attention has been paid to the influence of deep microbiological characteristics on patient prognosis. Our aim was to investigate whether microbiological genotypic and phenotypic features have a significant influence on infection pathogenesis and patient outcome. Methods A prospective multicenter study was performed, including all S. aureus PJIs (2016–2017). Clinical data and phenotypic (agr functionality, β-hemolysis, biofilm formation) and genotypic characteristics of the strains were collected. Biofilm susceptibility to antimicrobials was investigated (minimal biofilm eradication concentration [MBEC] assay). Results Eighty-eight patients (39.8% men, age 74.7 ± 14.1 years) were included. Forty-five had early postoperative infections (EPIs), 21 had chronic infections (CPIs), and 19 had hematogenous infections (HIs). Twenty (22.7%) were caused by methicillin-resistant S. aureus. High genotypic diversity was observed, including 16 clonal complexes (CCs), with CC5 being the most frequent (30.7%). agr activity was greater in EPI than CPI (55.6% vs 28.6%; P = .041). Strains causing EPI were phenotypically and genotypically similar, regardless of symptom duration. Treatment failure (36.5%) occurred less frequently among cases treated with implant removal. In cases treated with debridement and implant retention, there were fewer failures among those who received combination therapy with rifampin. No genotypic or phenotypic characteristics predicted failure, except vancomycin minimal inhibitory concentration ≥1.5 mg/L (23.1% failure vs 3.4%; P = .044). MBEC50 was >128 mg/L for all antibiotics tested and showed no association with prognosis. Conclusions S. aureus with different genotypic backgrounds is capable of causing PJI, showing slight differences in clinical presentation and pathogenesis. No major microbiological characteristics were observed to influence the outcome, including MBEC.