Publication: Biofilm properties in relation to treatment outcome in patients with first-time periprosthetic hip or knee joint infection
| dc.contributor.author | Malchau, Karin Svensson | |
| dc.contributor.author | Tillander, Jonatan | |
| dc.contributor.author | Zaborowska, Magdalena | |
| dc.contributor.author | Hoffman, Maria | |
| dc.contributor.author | Lasa Uzcudun, Íñigo | |
| dc.contributor.author | Thomsen, Peter | |
| dc.contributor.author | Malchau, Henrik | |
| dc.contributor.author | Rolfson, Ola | |
| dc.contributor.author | Trobos, Margarita | |
| dc.contributor.department | Ciencias de la Salud | es_ES |
| dc.contributor.department | Osasun Zientziak | eu |
| dc.date.accessioned | 2021-12-28T10:45:07Z | |
| dc.date.available | 2021-12-28T10:45:07Z | |
| dc.date.issued | 2021 | |
| dc.description.abstract | Background: periprosthetic joint infections (PJI) are challenging complications following arthroplasty. Staphylococci are a frequent cause of PJI and known biofilm producers. Biofilm formation decreases antimicrobial susceptibility, thereby challenging favourable treatment outcomes. The aims of this study were to characterize the biofilm abilities and antimicrobial susceptibilities of staphylococci causing first-time PJI and correlate them to clinical outcome (infection resolution and recurrence). Methods: reoperations for PJI of the hip or knee between 1st January 2012 to 30th June 2015 performed at the Sahlgrenska University Hospital were identified in a local database. Medical records were reviewed and clinical parameters recorded for patients whose intraoperative bacterial isolates had been stored at the clinical laboratory. Staphylococcal strains isolated from reoperations due to first-time PJI were characterised by their ability to form biofilms using the microtiter plate test. Antimicrobial susceptibility of the strains was determined by minimum inhibitory concentration (MIC) when grown planktonically, and by minimum biofilm eradication concentration (MBEC) when grown as biofilms. MBEC determination was conducted using the Calgary biofilm device (CBD) and a custom-made antimicrobial susceptibility plate containing eight clinically relevant antimicrobial agents. Results: the study group included 49 patients (70 bacterial strains) from first-time PJI, whereof 24 (49%) patients had recurrent infection. Strong biofilm production was significantly associated with recurrent infection. Patients infected with strong biofilm producers had a five-fold increased risk for recurrent infection. Strains grown as biofilms were over 8000 times more resistant to antimicrobial agents compared to planktonic cultures. Biofilms were more susceptible to rifampicin compared to other antimicrobials in the assay. Increased biofilm susceptibility (MBEC > MIC) was observed for the majority of the bacterial strains and antimicrobial agents. Conclusions: Strong biofilm production was significantly associated with increased antimicrobial resistance and PJI recurrence. This underscores the importance of determining biofilm production and susceptibility as part of routine diagnostics in PJI. Strong staphylococcal biofilm production may have implications on therapeutic choices and suggest more extensive surgery. Furthermore, despite the increased biofilm resistance to rifampicin, results from this study support its use in staphylococcal PJI. The Translational Potential of this Article: Like for many biomaterial-associated infections, staphylococci are a common cause of PJI. Their ability to adhere to surfaces and produce biofilms on medical devices is proposed to play a role. However, clinical studies where biofilm properties are directly linked to patient outcome are scarce. This study demonstrates that the majority of staphylococci isolated from first-time PJI were biofilm producers with increased antimicrobial resistance. Patients suffering an infection caused by a staphylococcal strain with strong biofilm production ability had a five-fold greater risk of recurrent infection. This novel finding suggests the importance of evaluating biofilm production as a diagnostic procedure for the guidance of treatment decisions in PJI. | en |
| dc.description.sponsorship | This work was sponsored by the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 754412 [MoRE2020 - Region Västra Götaland], CARe - Centre for Antibiotic Resistance Research at University of Gothenburg, Swedish Research Council [2018–02891], the Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement [ALFGBG-725641 ; ALFGBG-719961], the Inga-Britt and Arne Lundberg Foundation, the Hjalmar Svensson Foundation, Doctor Felix Neuberghs Foundation, the Adlerbertska Foundation, the Sylvan Foundation, Göteborgs Läkarsällskap/The Gothenburg Medical Society research grants [for PhD-studies and Svea Bäcksins grant GLS-780551 ], and the Area of Advance Materials of Chalmers/GU Biomaterials within the Strategic Research Area initiative launched by the Swedish government. | |
| dc.format.extent | 10 p. | |
| dc.format.mimetype | application/pdf | en |
| dc.identifier.doi | 10.1016/j.jot.2021.05.008 | |
| dc.identifier.issn | 2214-031X | |
| dc.identifier.uri | https://academica-e.unavarra.es/handle/2454/41507 | |
| dc.language.iso | eng | en |
| dc.publisher | Elsevier | en |
| dc.relation.ispartof | Journal of Orthopaedic Translation, 30, 31-40 | en |
| dc.relation.projectID | info:eu-repo/grantAgreement/European Commission/Horizon 2020 Framework Programme/754412 | en |
| dc.relation.publisherversion | http://doi.org/10.1016/j.jot.2021.05.008 | |
| dc.rights | © 2021 The Authors. Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International | es_ES |
| dc.rights.accessRights | info:eu-repo/semantics/openAccess | |
| dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ | |
| dc.subject | Antimicrobial resistance | en |
| dc.subject | Biofilm | en |
| dc.subject | Minimum biofilm eradication concentration | en |
| dc.subject | Periprosthetic joint infection | en |
| dc.subject | Staphylococci | en |
| dc.title | Biofilm properties in relation to treatment outcome in patients with first-time periprosthetic hip or knee joint infection | en |
| dc.type | info:eu-repo/semantics/article | |
| dc.type.version | info:eu-repo/semantics/publishedVersion | en |
| dc.type.version | Versión publicada / Argitaratu den bertsioa | es |
| dspace.entity.type | Publication | |
| relation.isAuthorOfPublication | c654d104-1ae2-41cf-9215-4b4bed3e5ea6 | |
| relation.isAuthorOfPublication.latestForDiscovery | c654d104-1ae2-41cf-9215-4b4bed3e5ea6 |