A four-year prospective study on microbial ecology of explanted prosthetic hips in 52 patients with “aseptic” prosthetic joint loosening

  • F. Perdreau-Remington
  • D. Stefanik
  • G. Peters
  • C. Ludwig
  • J. Riitt
  • R. Wenzel
  • G. Pulverer

Abstract

The bacteriology of explanted prosthetic hips and surrounding soft tissue was studied in 52 patients undergoing surgical revision for joint loosening. In a prospective four-year study, positive bacterial cultures were recorded in 34 (76%) patients. Coagulase-negative staphylococci were the predominant isolates, and 11 patients (33%) had more than three organisms isolated, 7 (20%) had two only, and 11 (33%) had one species. Among the 23 patients from whom specimens from all 11 predetermined anatomic sites were cultured, the highest frequency of positive cultures (52% and 47%) came from the shaft and capsular tissue, respectively. Organisms were less frequently recovered from the cement and acetabulum (13% and 4%, respectively). Using molecular typing in eight patients with paired isolates of the same species, clonal identity was found in four. An additional patient underwent a second revision for loosening 17 months after the first revision and the same clone ofStaphylococcus epidermidis was isolated on both occasions.

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References

  1. 1.
    Gierse H, Stahl C, Wissolowski T: Standortbestimmung der zementierten Hüftendoprothetik. In: Gierse H, Maaz B (ed): Die Hüft-Endoprothetik. Ecomed, Munich, 1991, p. 91–96.Google Scholar
  2. 2.
    Harris W: Osteolysis and particle disease in hip replacement. Acta Orthopaedica Scandinavica 1994, 65: 113–123.Google Scholar
  3. 3.
    Brause BD: Infected orthopedic prostheses. In: Bisno AL, Waldvogel FA (ed): Infections associated with indwelling medical devices. American Society for Microbiology, Washington, DC, 1989, p. 111–127.Google Scholar
  4. 4.
    Foerster G: Der einseitige Prothesenwechsel bei infizierter Hüftendoprothese. In: Gierse H, Maaz B (ed): Die HüftEndoprothetik. Ecomed, Munich, 1991, p. 49–58.Google Scholar
  5. 5.
    Peters G, Schumacher-Perdreau F, Jansen B, Ludwig C, Rütt R: “Aseptic” prosthetic hip loosening — a chronic polymer-associated infection by coagulase-negative staphylococci? Zentralblatt für Bakteriologie, 1991, 21, Supplement: 329–331.Google Scholar
  6. 6.
    Sugarman B, Young EY: Infections associated with prosthetic devices. Magnitude of the problem. Infectious Diseases Clinics of North America 1989, 3: 187–198.Google Scholar
  7. 7.
    Kloos WE, Schleifer KH: Simplified scheme for the routine identification of humanStaphylococcus species. Journal of Clinical Microbiology 1975, 1: 82–88.Google Scholar
  8. 8.
    Schumacher-Perdreau F: Clinical significance and laboratory diagnosis of coagulase-negative staphylococci. Clinical Microbiology Newsletter 1991, 13: 97–100.Google Scholar
  9. 9.
    Schumacher-Perdreau F, Heilmann C, Peters G, Götz F, Pulverer G: Comparative analysis of a biofilm-formingStaphylococcus epidermidis strain and its adhesion-positive, accumulation-negative mutant M7. FEMS Microbiology Letters 1994, 117: 71–78.Google Scholar
  10. 10.
    Laemmli UK: Cleavage of structural proteins during the assembly of the head of bacteriophage T4. Nature 1970, 227:680–685.Google Scholar
  11. 11.
    Naidoo J, Noble WC: Skin as a source of transferable antibiotic resistance in coagulase negative staphylococci. In: Pulverer G, Quie PG, Peters G (ed): Pathogenicity and clinical relevance of coagulase negative staphylococci. G. Fischer Verlag, Stuttgart, 1987, p. 225–232.Google Scholar
  12. 12.
    Schumacher-Perdreau F, Jansen B, Seifert H, Peters G, Pulverer G: Outbreak of methicillin-resistantStaphylococcus aureus in a teaching hospital epidemiological and microbiological surveillance. Zentralblatt für Bakteriologie 1994, 250: 550–559.Google Scholar
  13. 13.
    Jordens JZ, Hall LMC: Characterization of methicillin-resistantStaphylococcus aureus isolates by restriction endonuclease digestion of chromosomal DNA. Journal of Medical Microbiology 1988, 27: 117–123.Google Scholar
  14. 14.
    Meyers JA, Sanchez D, Ellwell LP, Falkow S: Simple agarose gel electrophoresis method for the identification and characterisation of plasmid deoxyribonucleic acid. Journal of Bacteriology 1976, 127: 1529–1537.Google Scholar
  15. 15.
    Goering RV, Duesning TD: Rapid field inversion gel electrophoresis in combination with an rRNA gene probe in the epidemiological evaluation of staphylococci. Journal of Clinical Microbiology 1990, 28: 426–429.Google Scholar
  16. 16.
    Mueller E, Hübner J, Gutierrez N, Takeda S, Goldmann DA, Pier GA: Isolation and characterisation of transposon mutants ofStaphylococcus epidermidis deficient in capsular polysaccharide adhesin and slime. Infection and Immunity 1993, 61:551–558.Google Scholar
  17. 17.
    Tojo M, Yamashita N, Goldmann DA, Pier GB: Isolation and characterisation of a polysaccharide adhesin fromStaphylococcus epidermidis. Journal of Infectious Diseases 1988, 157: 713–722.Google Scholar
  18. 18.
    Timmermann CP, Fleer A, Besnier JM, De Graaf L, Cremers F, Verhoef J: Characterisation of a capsular polysaccharide adhesin fromStaphylococcus epidermidis. Infection and Immunity 1991, 59: 4187–4192.Google Scholar
  19. 19.
    Hermann M, Vaudaux PE, Pittet D, Auckenthaler R, Lew PD, Schumacher-Perdreau F, Peters G, Waldvogel F: Fibronectin, fibrinogen, and laminin act as mediators of adherence of clinical staphylococcal isolates to foreign material. Journal of Infectious Diseases 1988, 158: 693–701.Google Scholar
  20. 20.
    Vaudaux P, Pittet D, Haeberli A, Huggler E, Nydegger UE, Lew DP, Waldvogel FA: Host factors selectively increase staphylococcal adherence on inserted catheters. Journal of Infectious Diseases 1989, 160: 865–875.Google Scholar
  21. 21.
    Jansen B, Schumacher-Perdreau F, Peters G, Pulverer G: New aspects in the pathogenesis and prevention of polymer-associated foreign body infections caused by coagulase-negative staphylococci. Journal of Investigative Surgery 1989, 2: 361–380.Google Scholar
  22. 22.
    Jansen B, Schumacher-Perdreau F, Peters F, Pulverer G: Evidence for degradation of synthetic polyurethanes byStaphylococcus epidermidis. Zentralblatt für Bakteriologie 1991, 276: 36–45.Google Scholar

Copyright information

© MMV Medizin Verlag GmbH Munchen 1996

Authors and Affiliations

  • F. Perdreau-Remington
    • 1
    • 2
  • D. Stefanik
    • 1
  • G. Peters
    • 3
  • C. Ludwig
    • 4
  • J. Riitt
    • 4
  • R. Wenzel
    • 5
  • G. Pulverer
    • 1
  1. 1.Institute of Medical Microbiology and HygieneUniversity of CologneCologneGermany
  2. 2.Department of Medicine, San Francisco General HospitalUniversity of CaliforniaSan FranciscoUSA
  3. 3.Orthopedic DepartmentUniversity of CologneCologneGermany
  4. 4.Institute of Medical MicrobiologyUniversity of MünsterMünsterGermany
  5. 5.Department of Internal MedicineUniversity of Iowa College of MedicineIowa CityUSA

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