Abstract
Staphylococcus epidermidis, ubiquitous in the human nasal and skin microbiota, is a common causative microorganism in prosthetic joint infections (PJIs). A high proportion of PJI isolates have been shown to harbor genetic traits associated with resistance to/tolerance of agents used for antimicrobial prophylaxis in joint arthroplasties. These traits were found within multidrug-resistant S. epidermidis (MDRSE) lineages of multiple genetic backgrounds. In this study, the aim was to study whether MDRSE lineages previously associated with PJIs are present in the nasal and skin microbiota of patients planned for arthroplasty surgery but before hospitalization. We cultured samples from nares, inguinal creases, and skin over the hip or knee (dependent on the planned procedure) taken two weeks (median) prior to admittance to the hospital for total joint arthroplasty from 66 patients on agar plates selecting for methicillin resistance. S. epidermidis colonies were identified and tested for the presence of mecA. Methicillin-resistant S. epidermidis (MRSE) were characterized by Illumina-based whole-genome sequencing. Using this method, we found that 30/66 (45%) of patients were colonized with MRSE at 1–3 body sites. A subset of patients, 10/66 (15%), were colonized with MDRSE lineages associated with PJIs. The qacA gene was identified in MRSE isolates from 19/30 (63%) of MRSE colonized patients, whereas genes associated with aminoglycoside resistance were less common, found in 11/30 (37%). We found that MDRSE lineages previously associated with PJIs were present in a subset of patients’ pre-admission microbiota, plausibly in low relative abundance, and may be selected for by the current prophylaxis regimen comprising whole-body cleansing with chlorhexidine-gluconate containing soap. To further lower the rate of S. epidermidis PJIs, the current prophylaxis may need to be modified, but it is important for possible perioperative MDRSE transmission events and specific risk factors for MDRSE PJIs to be investigated before reevaluating antimicrobial prophylaxis.
Highlights
Staphylococcus epidermidis is ubiquitous in the human microbiota of the skin and mucosal membranes
The mean age, which was 67 years (SD 10.4) for the entire study population, differed between hospitals: patients recruited from regional hospital A were older [mean age 70.6 (SD 10.8)] than patients recruited from university hospital C [mean age 59.4 (SD 7.7)] (p = 0.0004)
The aim was to investigate whether multidrug-resistant S. epidermidis (MDRSE) lineages associated with prosthetic joint infections (PJIs) are present in the nasal and skin microbiota of patients scheduled for prosthetic joint surgery before hospital admission
Summary
Staphylococcus epidermidis is ubiquitous in the human microbiota of the skin and mucosal membranes. S. epidermidis is in several ways beneficial to the human host, involved in the regulation of wound healing and defense against virulent pathogens such as Staphylococcus aureus [1], and is an important causative microorganism in healthcare-associated infections (HAI) [2], such as prosthetic joint infections (PJIs). PJIs are classified as acute hematogenous, early postoperative, or chronic [3] and are associated with significant morbidity [4] and mortality [5,6]. Due to the rising number of arthroplasty surgeries performed annually, the number of patients with PJIs is increasing [8,9,10,11]. In early postoperative and chronic PJIs, coagulase-negative staphylococci (CoNS) are the most common causative microorganisms, reported in 25–29%
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