title: 16S rRNA analysis provides evidence of biofilms on all components of three infected periprosthetic knees including permanent braided suture.
abstract: Bacterial biofilms are the main etiological agent of periprosthetic joint infections (PJI); however, it is unclear if biofilms colonize one or multiple components. Because biofilms can colonize a variety of surfaces, we hypothesized that biofilms would be present on all components. 16S ribosomal RNA (rRNA) gene sequencing analysis was used to identify bacteria recovered from individual components and non-absorbable suture material recovered from three PJI total knee revision cases. Bray-Curtis non-metric multidimensional scaling analysis revealed no significant differences in similarity when factoring component, material type, or suture versus non-suture material, but did reveal significant differences in organism profile between patients (P < 0.001) and negative controls (P < 0.001). Confocal microscopy and a novel agar encasement culturing method also confirmed biofilm growth on a subset of components. While 16S sequencing suggested that the microbiology was more complex than revealed by culture contaminating, bacterial DNA generates a risk of false positives. This report highlights that biofilm bacteria may colonize all infected prosthetic components including braided suture material, and provides further evidence that clinical culture can fail to sufficiently identify the full pathogen profile in PJI cases.
authors.affiliation: Center for Microbial Interface Biology, Department of Microbial Infection and Immunity, The Ohio State University, Biomedical Research Tower, 460 West 12th Avenue, Room 760, Columbus, OH 43210, USA.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Swearingen
authors.affiliation: School of Medicine, The Ohio State University, Mailing Hall, 370 West 9th Avenue, Columbus, OH 43210, USA.
authors.forename: Alex C
authors.initials: AC
authors.lastname: DiBartola
authors.affiliation: Center for Microbial Interface Biology, Department of Microbial Infection and Immunity, The Ohio State University, Biomedical Research Tower, 460 West 12th Avenue, Room 760, Columbus, OH 43210, USA.
authors.forename: Devendra
authors.initials: D
authors.lastname: Dusane
authors.affiliation: Department of Orthopaedics, The Ohio State University, 543 Taylor Avenue, Columbus, OH 43203, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Granger
authors.affiliation: Center for Microbial Interface Biology, Department of Microbial Infection and Immunity, The Ohio State University, Biomedical Research Tower, 460 West 12th Avenue, Room 760, Columbus, OH 43210, USA Department of Orthopaedics, The Ohio State University, 543 Taylor Avenue, Columbus, OH 43203, USA Engineering Sciences Unit, National Center for Advanced Tribology, University of Southampton, UK paul.stoodley@osumc.edu.
authors.forename: Paul
authors.initials: P
authors.lastname: Stoodley
mesh_terms: D000368:Aged; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000382:microbiology*; D001419:Bacteria / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D044822:Biodiversity; D018441:Biofilms; D006801:Humans; D007719:Knee Joint / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology*; D012336:RNA, Ribosomal, 16S / Q000235:genetics*; D017422:Sequence Analysis, DNA; D013537:Sutures / Q000382:microbiology*
chemical_list: D012336:RNA, Ribosomal, 16S
keywords: 16S rRNA gene phylogenetic analysis; biofilm; periprosthetic joint infection; permanent braided polyester suture; polymicrobial infection