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

Abstract

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.

Keywords: Staphylococcus aureus; antibiotic treatment; coagulase-negative staphylococci; periprosthetic joint infection; phases.

Figure 1.

Flow chart of selection process in the systematic review. PJI, periprosthetic joint infection.

Figure 2.

Comparison of MSSA and MRSA in 10 included studies. MSSA, methicillin-susceptible Staphylococcus aureus; MRSA, methicillin-resistant Staphylococcus aureus; Ip, Ip et al (28); Ph, Phillips et al (2); Mo, Moran et al (27); Te, Teterycz et al (19); Ts, Tsai et al (13); Ib, Ibrahim et al (41); Bj, Bjerke-Kroll et al (44); Ho, Holmber et al (40); Ma, Matsumoto et al (33); Tr, Triantafyllopoulos et al (43).