title: Sequence types of Staphylococcus epidermidis associated with prosthetic joint infections are not present in the laminar airflow during prosthetic joint surgery.
abstract: Molecular characterization of Staphylococcus epidermidis isolates from prosthetic joint infections (PJIs) has demonstrated a predominance of healthcare-associated multi-drug resistant sequence types (ST2 and ST215). How, and when, patients acquire these nosocomial STs is not known. The aim was to investigate if sequence types of S. epidermidis associated with PJIs are found in the air during prosthetic joint surgery. Air sampling was undertaken during 17 hip/knee arthroplasties performed in operating theaters equipped with mobile laminar airflow units in a 500-bed hospital in central Sweden. Species identification was performed using MALDI-TOF MS and 16S rRNA gene analysis. Isolates identified as S. epidermidis were further characterized by MLST and antibiotic susceptibility testing. Seven hundred and thirty-five isolates were available for species identification. Micrococcus spp. (n = 303) and coagulase-negative staphylococci (n = 217) constituted the majority of the isolates. Thirty-two isolates of S. epidermidis were found. S. epidermidis isolates demonstrated a high level of allelic diversity with 18 different sequence types, but neither ST2 nor ST215 was found. Commensals with low pathogenic potential dominated among the airborne microorganisms in the operating field during prosthetic joint surgery. Nosocomial sequence types of S. epidermidis associated with PJIs were not found, and other routes of inoculation are therefore of interest in future studies.
authors.affiliation: Faculty of Medicine and Health, Örebro University, Örebro, Sweden.|Centre for Clinical Research, Uppsala University, County Hospital, Västerås, Sweden.
authors.forename: Emeli
authors.initials: E
authors.lastname: Månsson
authors.affiliation: Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Hellmark
authors.affiliation: Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Sundqvist
authors.affiliation: Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Söderquist
mesh_terms: D000391:Air Microbiology / Q000592:standards*; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D024901:Drug Resistance, Multiple, Bacterial; D004780:Environment, Controlled; D004784:Environmental Monitoring; D060005:Genotyping Techniques; D006801:Humans; D007595:Joint Prosthesis / Q000382:microbiology; D008826:Microbial Sensitivity Tests; D058885:Multilocus Sequence Typing; D016459:Prosthesis-Related Infections / Q000382:microbiology*; D012336:RNA, Ribosomal, 16S / Q000302:isolation & purification; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; D013212:Staphylococcus epidermidis / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D013548:Sweden
chemical_list: D000900:Anti-Bacterial Agents; D012336:RNA, Ribosomal, 16S
keywords: ST2; ST215; Staphylococcus epidermidis; airborne transmission; prosthetic joint infections