JBJS | Direct Demonstration of Viable Staphylococcus aureus Biofilms in an Infected Total Joint Arthroplasty: A Case Report

The Journal of Bone & Joint Surgery, Volume 90, Issue 8

Case Reports | August 01, 2008

Direct Demonstration of Viable Staphylococcus aureus Biofilms in an Infected Total Joint Arthroplasty: A Case Report

Paul Stoodley, PhD¹; Laura Nistico, PhD¹; Sandra Johnson, BS¹; Leslie-Ann Lasko, PA-C¹; Mark Baratz, MD¹; Vikram Gahlot, MD¹; Garth D. Ehrlich, PhD¹; Sandeep Kathju, MD, PhD¹

¹ Center for Genomic Sciences, Allegheny-Singer Research Institute, (P.S., L.N., S.J., L.-A.L., M.B., V.G., G.D.E., and S.K.) and the Department of Microbiology and Immunology, Drexel University College of Medicine (Allegheny Campus) (P.S., G.D.E., and S.K.), Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212-4772. E-mail address for S. Kathju: skathju@wpahs.org

The Journal of Bone & Joint Surgery. 2008; 90:1751-1758 doi:10.2106/JBJS.G.00838

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Extract

Infection following total joint arthroplasty is difficult to diagnose and treat; a nascent body of evidence from studies of prosthetic joint infections suggests that biofilm bacteria are the underlying cause^1-3. We describe the case of a patient who had chronic recurring symptoms of infection that persisted for years following total elbow arthroplasty despite numerous medical and surgical interventions. Confocal microscopy performed on fluid, tissue, and cement at the final surgical revision demonstrated viable bacteria in biofilm aggregates. Reverse transcriptase-polymerase chain reaction analysis confirmed the presence of metabolically active Staphylococcus aureus. These observations comprise compelling evidence that viable biofilm bacteria play an important role in refractory infection following joint arthroplasty.

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Topics

staphylococcus aureus ; biofilms ; reverse transcriptase polymerase chain reaction ; arthroplasty ; microscopy, confocal ; polymerase chain reaction ; infection ; bacteria ; coccidioidomycosis ; nucleic acids

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These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.

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