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Staphylococcus aureus bacteremia is an issue of concern because of high rates of illness and death for this condition (1). Some studies have identified high MICs for vancomycin (defined as [...]

Background Staphylococcus aureus is the leading cause of prosthetic joint infection (PJI). Beyond the antibiogram, little attention has been paid to the influence of deep microbiological characteristics on patient prognosis. Our aim was to investigate whether microbiological genotypic and phenotypic features have a significant influence on infection pathogenesis and patient outcome. Methods A prospective multicenter study was performed, including all S. aureus PJIs (2016–2017). Clinical data and phenotypic (agr functionality, β-hemolysis, biofilm formation) and genotypic characteristics of the strains were collected. Biofilm susceptibility to antimicrobials was investigated (minimal biofilm eradication concentration [MBEC] assay). Results Eighty-eight patients (39.8% men, age 74.7 ± 14.1 years) were included. Forty-five had early postoperative infections (EPIs), 21 had chronic infections (CPIs), and 19 had hematogenous infections (HIs). Twenty (22.7%) were caused by methicillin-resistant S. aureus. High genotypic diversity was observed, including 16 clonal complexes (CCs), with CC5 being the most frequent (30.7%). agr activity was greater in EPI than CPI (55.6% vs 28.6%; P  = .041). Strains causing EPI were phenotypically and genotypically similar, regardless of symptom duration. Treatment failure (36.5%) occurred less frequently among cases treated with implant removal. In cases treated with debridement and implant retention, there were fewer failures among those who received combination therapy with rifampin. No genotypic or phenotypic characteristics predicted failure, except vancomycin minimal inhibitory concentration ≥1.5 mg/L (23.1% failure vs 3.4%; P  = .044). MBEC50 was >128 mg/L for all antibiotics tested and showed no association with prognosis. Conclusions S. aureus with different genotypic backgrounds is capable of causing PJI, showing slight differences in clinical presentation and pathogenesis. No major microbiological characteristics were observed to influence the outcome, including MBEC. [ABSTRACT FROM AUTHOR]

A large series of staphylococcal prosthetic joint infection managed conservatively. A substantial number of patients fail early after debridement. Rifampin may contribute to homogenizing the methicillin-resistant Staphylococcus aureus– and methicillin-susceptible S. aureus–prognosis, although efficacy may vary depending on the specific rifampin combination used.Background. Several series predicting the prognosis of staphylococcal prosthetic joint infection (PJI) managed with debridement, antibiotics, and implant retention (DAIR) have been published, but some of their conclusions are controversial. At present, little is known regarding the efficacy of the different antibiotics that are used or their ability to eliminate methicillin-resistant S. aureus (MRSA) infection.Methods. This was a retrospective, multicenter, observational study of cases of PJI by S. aureus that were managed with DAIR (2003–2010). Cases were classified as failures when infection persistence/relapse, death, need for salvage therapy, or prosthesis removal occurred. The parameters that predicted failure were analyzed with logistic and Cox regression.Results. Out of 345 episodes (41% men, 73 years), 81 episodes were caused by MRSA. Fifty-two were hematogenous, with poorer prognoses, and 88% were caused by methicillin-susceptible S. aureus (MSSA). Antibiotics were used for a median of 93 days, with similar use of rifampin-based combinations in MSSA- and MRSA-PJI. Failure occurred in 45% of episodes, often early after debridement. The median survival time was 1257 days. There were no overall prognostic differences between MSSA- and MRSA-PJI, but there was a higher incidence of MRSA-PJI treatment failure during the period of treatment (HR 2.34), while there was a higher incidence of MSSA-PJI treatment failure after therapy. Rifampin-based combinations exhibited an independent protective effect. Other independent predictors of outcome were polymicrobial, inflammatory, and bacteremic infections requiring more than 1 debridement, immunosuppressive therapy, and the exchange of removable components of the prosthesis.Conclusions. This is the largest series of PJI by S. aureus managed with DAIR reported to date. The success rate was 55%. The use of rifampin may have contributed to homogenizing MSSA and MRSA prognoses, although the specific rifampin combinations may have had different efficacies. [ABSTRACT FROM PUBLISHER]

Temporal and spatial changes in the coverage of five Ulva L. species (U. prolifera O.F. Müller, U. intestinalis L., U. hookeriana (Kützing) Hayden et al., U. compressa L. and U. linza L.) were analyzed on rocky substrata experimentally immersed in Comodoro Rivadavia Harbor (Argentina). Colonization was studied during an annual period at three levels: upper intertidal, middle intertidal and subtidal. Coverage was significantly higher in the middle intertidal and subtidal levels than in the upper intertidal level, where all species of Ulva were absent. Seasonal changes were also significant: coverage in summer and spring was significantly higher than in autumn and winter. Most species showed high spatial variability among replicates from the same level and season. Zonation patterns within the harbor differed from those observed in natural areas, probably due to low wave exposure and its interaction with herbivory and desiccation stress. Colonization patterns observed in this study indicate niche segregation in closely related species of the genus Ulva. [ABSTRACT FROM AUTHOR]

This retrospective, multicenter observational study aimed to describe the outcomes of surgical and medical treatment of C. acnes-related prosthetic joint infection (PJI) and the potential benefit of rifampin-based therapies. Patients with C. acnes-related PJI who were diagnosed and treated between January 2003 and December 2016 were included. We analyzed 44 patients with C. acnes-related PJI (median age, 67.5 years (IQR, 57.3–75.8)); 75% were men. The majority (61.4%) had late chronic infection according to the Tsukayama classification. All patients received surgical treatment, and most antibiotic regimens (43.2%) included β-lactam. Thirty-four patients (87.17%) were cured; five showed relapse. The final outcome (cure vs. relapse) showed a nonsignificant trend toward higher failure frequency among patients with previous prosthesis (OR: 6.89; 95% CI: 0.80–58.90) or prior surgery and infection (OR: 10.67; 95% IC: 1.08–105.28) in the same joint. Patients treated with clindamycin alone had a higher recurrence rate (40.0% vs. 8.8%). Rifampin treatment did not decrease recurrence in patients treated with β-lactams. Prior prosthesis, surgery, or infection in the same joint might be related to recurrence, and rifampin-based combinations do not seem to improve prognosis. Debridement and implant retention appear a safe option for surgical treatment of early PJI. [ABSTRACT FROM AUTHOR]

Background.: Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success., Methods.: A retrospective, observational, multicenter, international study was performed during 2003-2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The primary endpoint was failure, defined as death related to infection, relapse/persistence of infection, or the need for salvage therapy., Results.: Overall, 462 cases were included (median age 72 years, 50% men). The most frequent species was Streptococcus agalactiae (34%), and 52% of all cases were hematogenous. Antibiotic treatment was primarily using β-lactams, and 37% of patients received rifampin. Outcomes were evaluable in 444 patients: failure occurred in 187 (42.1%; 95% confidence interval, 37.5%-46.7%) after a median of 62 days from debridement; patients without failure were followed up for a median of 802 days. Independent predictors (hazard ratios) of failure were rheumatoid arthritis (2.36), late post-surgical infection (2.20), and bacteremia (1.69). Independent predictors of success were exchange of removable components (0.60), early use of rifampin (0.98 per day of treatment within the first 30 days), and long treatments (≥21 days) with β-lactams, either as monotherapy (0.48) or in combination with rifampin (0.34)., Conclusions.: This is the largest series to our knowledge of streptococcal PJI managed by DAIR, showing a worse prognosis than previously reported. The beneficial effects of exchanging the removable components and of β-lactams are confirmed and maybe also a potential benefit from adding rifampin., (© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Introduction: The chromogenic medium, XG, was evaluated and compared to conventional media for the isolation of Salmonella spp., Shigella spp., Yersinia enterocolitica and Aeromonas spp., Methods: A total of 1226 human stool samples were inoculated on XG, MacConkey agar, Salmonella-Shigella agar (SS), selenite broth, blood-ampicillin agar and cefsulodin-Irgasan-novobiocin agar (CIN)., Results: The 235 positive cultures included the following: 229 Salmonella spp., 3 Shigella spp., 2 Yersinia enterocolitica and one Aeromonas spp. Among the 229 containing Salmonella spp., 100 were detected on both XG and conventional media and the 129 remaining were detected only on conventional media; recovery of Salmonella spp. on conventional media was significantly higher with respect to XG medium (p < 0.005). The 3 isolates of Shigella spp. were obtained on XG, the 2 isolates of Yersinia enterocolitica were recovered on CIN agar and the single isolate of Aeromonas spp. was obtained both on XG and blood-ampicillin agar. Colonies suspected to be some of the enteropathogens investigated were present in 791 of the negative stool samples. Among these false-positives 441 (35.9%) were obtained from XG, 142 (11.6%) after selenite enrichment, 132 (10.8%) from MacConkey agar and 76 (6.2%) from SS agar. Most of the false-positive isolates obtained on XG medium were consistent with Salmonella spp. (n = 408)., Conclusions: XG chromogenic medium showed low sensitivity (64%) and specificity (69%) for the detection of Salmonella spp. Recovery of Shigella spp. on XG medium in three samples may have been due to the immediate processing of the samples. We conclude that XG chromogenic medium can not be recommended as an alternative to currently used conventional media.