The Hip: Preservation, Replacement and Revision

Staph epidermidis

  - Discussion:
    - is a coagulase negative, gram positive organism;
    - has emerged as one of the most common organisms in total joint infections (and in other implanted devices);
    - it is often minimally toxic (as compared to other bacterial infections), and many patients will have minimal symptoms of infection;
    - it is particularly prone to recurrence following joint replantation; 
    - ref: Infection in total joint replacements. Why we screen MRSA when MRSE is the problem?
    - biofilm and colonization of implants:
           - its high recurrence rate may be related to its propensity to form a biofilm layer (extra-cellular glycocalyx) which coats the bacteria, which protects by engulfment by neutrophils;
            - slime layer may make antibiotic penetration and bacteria eradication more difficult; 
            - references:
                    - Adherence of Staphylococcus epidermidis to biomaterials is augmented by PIA.
                    - Occurrence of ica genes for slime synthesis in a collection of Staphylococcus epidermidis strains from orthopedic prosthesis infections.
                    - Surgical biomaterials and differential colonization by Staphylococcus epidermidis. 
                    - Bacterial adherence to bioinert and bioactive materials studied in vitro. 
                    - SdrF, a Staphylococcus epidermidis surface protein, binds type I collagen.
                    - Identification and preliminary characterization of cell-wall-anchored proteins of Staphylococcus epidermidis.
                    - Screening for Staphylococcus epidermidis markers discriminating between skin-flora strains and those responsible for infections of joint prostheses.

       - vancomycin 
            - reference:
                  -  Medical Intelligence: Emergence of Vancomycin Resistance In Coagulase-Negative Staphylococci

    - zyvox 
            - reference:
                  - [Linezolid in the treatment of antibiotic-resistant gram-positive infections of the musculoskeletal system.

    - controversies:
            - treatment of staph implant related infection:
            - in the report by Konig, et al, authors report on success of a single case of staph epi infection over an orthopaedic implant w/ combo of rifampin and cipro;
            - references: 
                      - Treatment of staphylococcal implant infection with rifampicin-ciprofloxacin in stable implants
                       - Open debridement of acute gram-positive infections after total knee arthroplasty
                       - Successful treatment of Staphylococcus epidermidis hip prosthesis infection with oral linezolid.

Does surgical prophylaxis with teicoplanin constitute a therapeutic advance?

Impetigo contagiosa III. Comparative efficacy of oral erythromycin and topical mupirocin.

Antimicrobial susceptibility of coagulase-negative staphylococci on tissue allografts and isolates from orthopedic patients.

Antibiotic resistance in exopolysaccharide-forming Staphylococcus epidermidis clinical isolates from orthopaedic implant infections.


- Treatment

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, November 27, 2012 2:30 pm