Alteration of Bacterial Communities in Anterior Nares and Skin Sites of Patients Undergoing Arthroplasty Surgery: Analysis by 16S rRNA and Staphylococcal-Specific tuf Gene Sequencing.

Søren Iversen,Anna Cäcilia Ingham,Sofie Marie Edslev,Åsa Nilsdotter-Augustinsson,Marc Stegger,Thor Bech Johannesen,Bo Söderquist,Emeli Månsson,Staffan Tevell,Paal Skytt Andersen

doi:10.3390/microorganisms8121977

Abstract

The aim was to study alterations of bacterial communities in patients undergoing hip or knee arthroplasty to assess the impact of chlorhexidine gluconate soap decolonisation and systemic antibiotic prophylaxis. A Swedish multicentre, prospective collection of samples obtained from elective arthroplasty patients (n = 83) by swabbing anterior nares, skin sites in the groin and the site of planned surgery, before and after arthroplasty surgery, was analysed by 16S rRNA (V3-V4) gene sequencing and a complementary targeted tuf gene sequencing approach to comprehensively characterise alterations in staphylococcal communities. Significant reductions in alpha diversity was detected for both bacterial (p = 0.04) and staphylococcal (p = 0.03) groin communities after arthroplasty surgery with significant reductions in relative Corynebacterium (p = 0.001) abundance and Staphylococcus hominis (p = 0.01) relative staphylococcal abundance. In nares, significant reductions occurred for Staphylococcus hominis (p = 0.02), Staphylococcus haemolyticus (p = 0.02), and Staphylococcus pasteuri (p = 0.003) relative to other staphylococci. Staphylococcus aureus colonised 35% of anterior nares before and 26% after arthroplasty surgery. Staphylococcus epidermidis was the most abundant staphylococcal species at all sampling sites. No bacterial genus or staphylococcal species increased significantly after arthroplasty surgery. Application of a targeted tuf gene sequencing approach provided auxiliary staphylococcal community profiles and allowed species-level characterisation directly from low biomass clinical samples.

Highlights

Arthroplasties are common surgical procedures performed to alleviate pain and to restore function in damaged or worn-out joints
A large proportion of the bacterial communities were not included in the analysis as too few reads (< 2000) remained after contaminant filtering, especially for samples obtained from groin and operation sites following decolonisation treatment and arthroplasty surgery (Table S1 and Figures S1 and S2)
principal coordinates analysis (PCoA) analysis showed that bacterial communities clustered according to body site (Figure 1A) and PERMANOVA revealed no significant difference (p = 0.2) in nasal bacterial community structure before compared to after decolonisation treatment and arthroplasty surgery (Figure 1B)

Summary

Introduction

Arthroplasties are common surgical procedures performed to alleviate pain and to restore function in damaged or worn-out joints. Colonising opportunistic pathogens (COPs) constitute part of the normal human microbiota [1] and comprise a risk for establishment of a prosthetic joint infection (PJI) [2]. Surgical procedures that entail breaching the epidermal protective layer increase the risk of invasive infections and an estimated 70–95% of all surgical site infections (SSIs) arise from a COP residing in the microbiota of a patient [3]. PJI incidence rates vary from low in hips, knees and shoulders (

Methods

Results

Discussion

Conclusion