Posts filed under ‘Bacterias’

Staphylococcus capitis isolated from prosthetic joint infections.

Eur J Clin Microbiol Infect Dis. Jan 2017 V.36 N.1 P.115-122.

Tevell S1,2, Hellmark B3, Nilsdotter-Augustinsson Å4, Söderquist B5.

Author information

1 Department of Infectious Diseases, Karlstad Hospital, Karlstad, Sweden.

2 School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

3 Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

4 Department of Infectious Diseases and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.

5 School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.


Further knowledge about the clinical and microbiological characteristics of prosthetic joint infections (PJIs) caused by different coagulase-negative staphylococci (CoNS) may facilitate interpretation of microbiological findings and improve treatment algorithms. Staphylococcus capitis is a CoNS with documented potential for both human disease and nosocomial spread. As data on orthopaedic infections are scarce, our aim was to describe the clinical and microbiological characteristics of PJIs caused by S. capitis. This retrospective cohort study included three centres and 21 patients with significant growth of S. capitis during revision surgery for PJI between 2005 and 2014. Clinical data were extracted and further microbiological characterisation of the S. capitis isolates was performed. Multidrug-resistant (≥3 antibiotic groups) S. capitis was detected in 28.6 % of isolates, methicillin resistance in 38.1 % and fluoroquinolone resistance in 14.3 %; no isolates were rifampin-resistant. Heterogeneous glycopeptide-intermediate resistance was detected in 38.1 %. Biofilm-forming ability was common. All episodes were either early post-interventional or chronic, and there were no haematogenous infections. Ten patients experienced monomicrobial infections. Among patients available for evaluation, 86 % of chronic infections and 70 % of early post-interventional infections achieved clinical cure; 90 % of monomicrobial infections remained infection-free. Genetic fingerprinting with repetitive sequence-based polymerase chain reaction (rep-PCR; DiversiLab®) displayed clustering of isolates, suggesting that nosocomial spread might be present. Staphylococcus capitis has the potential to cause PJIs, with infection most likely being contracted during surgery or in the early postoperative period. As S. capitis might be an emerging nosocomial pathogen, surveillance of the prevalence of PJIs caused by S. capitis could be recommended.


June 22, 2017 at 5:54 pm

Distribution characteristics of Staphylococcus spp. in different phases of periprosthetic joint infection: A review.

Exp Ther Med. 2017 Jun;13(6):2599-2608.

Guo G1, Wang J1, You Y2, Tan J1, Shen H1.

Author information

1 Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, P.R. China.

2 Department of Obstetrics, Fudan University Affiliated Obstetrics and Gynecology Hospital, Shanghai 200233, P.R. China.


Periprosthetic joint infection (PJI) is a devastating condition and Staphylococcus spp. are the predominant pathogens responsible, particularly coagulase-negative staphylococci (CoNS) and Staphylococcus aureus.

The aim of the present systematic review was to evaluate the distribution characteristics of specific Staphylococcus spp. in different PJI phases, reveal the effect of pathogens’ feature on their distribution and suggest recommendations for antibiotic treatment of Staphylococcal PJI.

The present systematic review was performed using PubMed and EMBASE databases with the aim to identify existing literature that presented the spectrum of Staphylococcus spp. that occur in PJI. Once inclusion and exclusion criteria were applied, 20 cohort studies involving 3,344 cases in 3,199 patients were included.

The predominant pathogen involved in PJI was indicated to be CoNS (31.2%), followed by S. aureus (28.8%). This trend was more apparent in hip replacement procedures. In addition, almost equal proportions of CoNS and S. aureus (28.6 and 30.0%, respectively) were indicated in the delayed phase. CoNS (36.6%) were the predominant identified organism in the early phase, whereas S. aureus (38.3%) occurred primarily in the late phase.

In PJI caused by S. aureus, the number of cases of methicillin-sensitive Staphylococcus aureus (MSSA) was ~2.5-fold greater than that of methicillin-resistant Staphylococcus aureus (MRSA). MRSA occurred predominantly in the early phase, whereas MSSA was largely observed in the delayed and late phases.

With regards to antibiotic treatment, the feature of various pathogens and the phases of PJI were the primary considerations.

The present review provides useful information for clinical practice and scientific research of PJI.


June 22, 2017 at 5:29 pm

Progress in the Fight Against Multidrug-Resistant Bacteria 2005–2016: Modern Noninferiority Trial Designs Enable Antibiotic Development in Advance of Epidemic Bacterial Resistance

Clinical Infectious Diseases July 2017 V.65 N.1 P.141-146

John H. Rex  George H. Talbot  Mark J. Goldberger  Barry I. Eisenstein  Roger M. Echols John F. Tomayko  Michael N. Dudley  Aaron Dane

From a public health perspective, new antibacterial agents should be evaluated and approved for use before widespread resistance to existing agents emerges.

However, for multidrug-resistant pathogens, demonstration of superior efficacy of a new agent over a current standard-of-care agent is routinely feasible only when epidemic spread of these dangerous organisms has already occurred.

One solution to enable proactive drug development is to evaluate new antibiotics with improved in vitro activity against MDR pathogens using recently updated guidelines for active control, noninferiority trials of selected severe infections caused by more susceptible pathogens.

Such trials are feasible because they enroll patients with infections due to pathogens with a “usual drug resistance” phenotype that will be responsive to widely registered standard-of-care comparator antibiotics.

Such anticipatory drug development has constructively reshaped the antibiotic pipeline and offers the best chance of making safe and efficacious antibiotics available to the public ahead of epidemic resistance.



June 22, 2017 at 3:37 pm

Practice Patterns and Outcomes Associated With Procalcitonin Use in Critically Ill Patients With Sepsis.

Clin Infect Dis. Jun. 1, 2017 V.64 N.11 P.1509-1515.

Chu DC1, Mehta AB1, Walkey AJ1,2.

Author information

1 The Pulmonary Center, Boston University School of Medicine and Division of Pulmonary, Allergy, and Critical Care Medicine Internal Medicine, and.

2 Center for Implementation and Improvement Sciences, Boston Medical Center, Massachusetts.



Randomized trials support use of procalcitonin (PCT)-based algorithms to decrease duration of antibiotics for critically ill patients with sepsis. However, current use of PCT and associated outcomes in real-world clinical settings is unclear. We sought to determine PCT use in critically ill patients with sepsis in the United States and to examine associations between PCT use and clinical outcomes.


This was a retrospective cohort study of approximately 20% of patients with sepsis hospitalized in US intensive care units. Hierarchical regression models were used to determine associations of PCT use with outcomes (antibiotic-days, incidence of Clostridium difficile infection, and in-hospital mortality). Sensitivity analyses were conducted to assess robustness of findings to different methods used to address unmeasured confounding (eg, instrumental variable, difference-in-differences analyses).


Among 20750 critically ill patients with sepsis in 107 hospitals with PCT available, 3769 (18%) patients had PCT levels checked; 1119 (29.7%) had serial PCT measurements. PCT use was associated with increased antibiotic-days (adjusted relative risk, 1.1; 95% confidence interval [CI], 1.15-1.18) and incidence of C. difficile (adjusted odds ratio, 1.42; 95% CI, 1.09-1.85) without a change in mortality (adjusted hazard ratio, 1.05; 95% CI, 0.93-1.19). Analysis of PCT use by instrumental variable and difference-in-difference analyses showed similar lack of antibiotic or outcome improvements associated with PCT use.


PCT use was not associated with improved antibiotic use or other clinical outcomes in real-world settings. Programs to improve implementation of PCT-based strategies are warranted prior to widespread adoption.


June 21, 2017 at 10:07 pm

Brucella melitensis prosthetic joint infection.

J Bone Jt Infect. 2017 Apr 5;2(3):136-142.         doi: 10.7150/jbji.18408. eCollection 2017.

Flury D1, Behrend H2, Sendi P3, von Kietzell M1, Strahm C1.

Author information

1 Department of Infectious Diseases, Cantonal Hospital of St. Gallen, St. Gallen.

2 Department of Orthopaedics and Traumatology, Cantonal Hospital of St. Gallen, St. Gallen.

3 Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.


Periprosthetic joint infection (PJI) due to Brucella spp. is rare.

We report a case in a 75-year-old man and review 29 additional cases identified in a literature search. The diagnosis of Brucella PJI is challenging, in particular in non-endemic countries.

Serological tests prior to joint aspiration or surgical intervention are reasonable. Involvement of infection control and timely information to laboratory personnel is mandatory upon diagnosis.

There is no uniform treatment concept, neither with respect to surgical intervention nor for the duration of antimicrobials.

Most cases have a successful outcome, irrespective of surgical modality, and with an antimicrobial combination regimen for 12 or more weeks.


June 21, 2017 at 7:59 am

Staphylococcus lugdunensis, a serious pathogen in periprosthetic joint infections: comparison to Staphylococcus aureus and Staphylococcus epidermidis.

Int J Infect Dis. Oct. 2016 V.51 P56-61.

Lourtet-Hascoët J1, Bicart-See A2, Félicé MP3, Giordano G4, Bonnet E2.

Author information

1 Microbiological Laboratory, Hôpital J. Ducuing, 15 rue Varsovie, 31300 Toulouse, France. Electronic address:

2 Infectious Diseases Mobile Unit, J. Ducuing Hospital, Toulouse, France.

3 Microbiological Laboratory, Hôpital J. Ducuing, 15 rue Varsovie, 31300 Toulouse, France.

4 Traumatology and Orthopaedic Surgery Department, J. Ducuing Hospital, Toulouse, France.



The aim of this study was to assess the characteristics of periprosthetic joint infection (PJI) due to Staphylococcus lugdunensis and to compare these to the characteristics of PJI due to Staphylococcus aureus and Staphylococcus epidermidis.


A retrospective multicentre study including all consecutive cases of S. lugdunensis PJI (2000-2014) was performed. Eighty-eight cases of staphylococcal PJI were recorded: 28 due to S. lugdunensis, 30 to S. aureus, and 30 to S. epidermidis, as identified by Vitek 2 or API Staph (bioMérieux).


Clinical symptoms were more often reported in the S. lugdunensis group, and the median delay between surgery and infection was shorter for the S. lugdunensis group than for the S. aureus and S. epidermidis groups. Regarding antibiotic susceptibility, the S. lugdunensis strains were susceptible to antibiotics and 61% of the patients could be treated with levofloxacin + rifampicin. The outcome of the PJI was favourable for 89% of patients with S. lugdunensis, 83% with S. aureus, and 97% with S. epidermidis.


S. lugdunensis is an emerging pathogen with a pathogenicity quite similar to that of S. aureus. This coagulase-negative Staphylococcus must be identified precisely in PJI, in order to select the appropriate surgical treatment and antibiotics .


June 20, 2017 at 7:44 pm

Clindamycin-rifampin combination therapy for staphylococcal periprosthetic joint infections: a retrospective observational study.

BMC Infect Dis. May 2, 2017 V.17 N.1 P.321.

Leijtens B1, Elbers JBW2, Sturm PD3, Kullberg BJ4, Schreurs BW2.

Author information

1 Department of Orthopaedic Surgery, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.

2 Department of Orthopaedic Surgery, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.

3 Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.

4 Department of Internal Medicine and Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands.



Staphylococcal species account for more than 50% of periprosthetic joint infections (PJI) and antimicrobial therapy with rifampin-based combination regimens has been shown effective. The present study evaluates the safety and efficacy of clindamycin in combination with rifampin for the management of staphylococcal PJI.


In this retrospective cohort study, patients were included who received clindamycin-rifampin combination therapy to treat a periprosthetic hip or knee infection by Staphylococcus aureus or coagulase-negative staphylococci. Patients were treated according to a standardized treatment algorithm and followed for a median of 54 months. Of the 36 patients with periprosthetic staphylococcal infections, 31 had an infection of the hip, and five had an infection of the knee. Eighteen patients underwent debridement and retention of the implant (DAIR) for an early infection, the other 18 patients underwent revision of loose components in presumed aseptic loosening with unexpected positive cultures.


In this study, we report a success rate of 86%, with five recurrent/persistent PJI in 36 treated patients. Cure rate was 78% (14/18) in the DAIR patients and 94% (17/18) in the revision group. Five patients (14%) discontinued clindamycin-rifampin due to side effects. Of the 31 patients completing the clindamycin-rifampin regimen 29 patients (94%) were cured.


Combined therapy with clindamycin and rifampin is a safe, well tolerated and effective regimen for the treatment of staphylococcal periprosthetic infection.


June 20, 2017 at 7:11 pm

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