Abstract
BackgroundA particular ability of the Staphylococcus aureus clonal complex 398 (CC398) to cause bone and joint infections (BJI) remains questionable, since some studies have described high prevalence of MSSA CC398 in prosthetic joint infection (PJI) and diabetic foot ostemolyelitis (DFO). Here, we described the long-term epidemiology of CC398 among S. aureus isolated from BJI and identified risk factors associated with CC398.MethodsWe included all bone and joint samples with S. aureus-positive culture in our university hospital between January 2010 and December 2017. Logistic regression was used for univariate and multivariate analysis.ResultsWe identified 124 CC398 isolates among the 958 BJI-associated S. aureus. The proportion of CC398 among S. aureus increased steadily from 4% in 2010 to 26% in 2017. Only 4 isolates of CC398 were resistant to methicillin. The distribution of BJI types due to CC398 and non CC398 isolates was similar. In multivariate analysis, age (p = 0.034, OR = 3.9), McCabe score (p = 0.005, OR = 5) and inoculation mechanism (p = 0.020, OR = 3.7) were associated with PJI-related CC398. The year of infection (p < 0.001, OR = 1.6), Charlson’s score (p = 0.001, OR = 1.5) and grade 4 (severe) of the International Working Group of the Diabetic Foot classification (p < 0.001, OR = 8.5) were associated with DFO-related CC398.ConclusionWe highlighted here the emergence and spread of CC398-MSSA in BJI. Patients with comorbidities are at high risk of CC398 MSSA PJI and DFO. The spread of CC398 in the community and hospital settings remains unclear and further epidemiological studies are needed to identify the determinants of its success.
Highlights
A particular ability of the Staphylococcus aureus clonal complex 398 (CC398) to cause bone and joint infections (BJI) remains questionable, since some studies have described high prevalence of Methicillin-Susceptible S. aureus (MSSA) CC398 in prosthetic joint infection (PJI) and diabetic foot ostemolyelitis (DFO)
Whereas MethicillinResistant S. aureus (MRSA) CC398 is associated with livestock and most often responsible of colonization and mild infection in humans and animals [3], Methicillin-Susceptible S. aureus (MSSA) CC398 is a frequent source of infections in humans, and was described frequently in severe infections such as bloodstream infections (BSI) [4, 5]
The frequency of CC398 PJI isolates varied from 1.8 to 14% [7, 8] whereas 21.7% of isolates belonged to CC398 in patients with DFO [9]
Summary
A particular ability of the Staphylococcus aureus clonal complex 398 (CC398) to cause bone and joint infections (BJI) remains questionable, since some studies have described high prevalence of MSSA CC398 in prosthetic joint infection (PJI) and diabetic foot ostemolyelitis (DFO). We described the long-term epidemiology of CC398 among S. aureus isolated from BJI and identified risk factors associated with CC398. Bone and joint infections (BJI) are a heterogeneous disease in their pathophysiology, clinical presentation, and management [1] and Staphylococcus aureus is the most common pathogen in almost all types of BJIs. Foot ulcers are common in diabetic patients and bone infection is a major causal factor for lower-limb amputation [2]. Prosthetic joint infection (PJI) remains a dreaded complication following total joint arthroplasty. The Bouiller et al BMC Infectious Diseases (2020) 20:384 incidence of BSIs due to MSSA CC398 has been increasing since 2007 in France [6]
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