Staphylococcus aureus versus Staphylococcus epidermidis in periprosthetic joint infection—Outcome analysis of methicillin-resistant versus methicillin-susceptible strains

• Published in: Diagnostic microbiology and infectious disease 2019-02, Vol.93 (2), p.125-130
• Main Authors: Hischebeth, GT, Randau, TM, Ploeger, MM, Friedrich, MJ, Kaup, E., Jacobs, C., Molitor, E., Hoerauf, A., Gravius, S., Wimmer, MD
• Format: Article
• Language: English
• Subjects: Arthroplasty; Hip; Knee; MRSA; MRSE; Periprosthetic joint infection; PJI
• ISSN: 0732-8893; 1879-0070
• DOI: 10.1016/j.diagmicrobio.2018.08.012

Periprosthetic joint infections (PJIs) are a major complication in total joint arthroplasty. Staphylococcus aureus and coagulase-negative staphylococci are known to cause the majority of all PJIs. This study aimed to analyze the eradication rates of S. aureus and S. epidermidis with methicillin susceptibility and methicillin resistance in a 2-stage therapy algorithm. Seventy-four patients with PJI caused by methicillin-resistant S. aureus (MRSA), methicillin-resistant coagulase-negative staphylococci (MRSE), methicillin-susceptible S. aureus (MSSA), and methicillin-susceptible coagulase-negative staphylococci (MSSE) were included, and the outcome was analyzed retrospectively. After a minimal follow-up of 2 years, n = 56 patients (75.7%) were definitively free of infection. The analysis revealed significant differences between the groups, with eradication rates as follows: MSSA (92.6%), MSSE (95.2%), MRSA (80%), and MRSE (54.2%). MRSE showed a significantly lower rate of patients graded as “definitively free of infection” as compared to patients with infections caused by MSSA, MSSE, and MRSA. •The main causative bacteria in PJI are Staphylococcus species.•Staphylococci differ in antimicrobial susceptibility and therefore in outcome.•Clinical resolution of infection was statistically reduced in MRSE.