Current Reviews in Musculoskeletal Medicine

, Volume 11, Issue 3, pp 389–400 | Cite as

Staphylococcus aureus Evasion of Host Immunity in the Setting of Prosthetic Joint Infection: Biofilm and Beyond

  • Benjamin F. Ricciardi
  • Gowrishankar Muthukrishnan
  • Elysia Masters
  • Mark Ninomiya
  • Charles C. Lee
  • Edward M. SchwarzEmail author
Prosthetic Joint Infection (S Nodzo and N Frisch, section editors)
Part of the following topical collections:
  1. Topical Collection on Prosthetic Joint Infection


Purpose of Review

The incidence of complications from prosthetic joint infection (PJI) is increasing, and treatment failure remains high. We review the current literature with a focus on Staphylococcus aureus pathogenesis and biofilm, as well as treatment challenges, and novel therapeutic strategies.

Recent Findings

S. aureus biofilm creates a favorable environment that increases antibiotic resistance, impairs host immunity, and increases tolerance to nutritional deprivation. Secreted proteins from bacterial cells within the biofilm and the quorum-sensing agr system contribute to immune evasion. Additional immunoevasive properties of S. aureus include the formation of staphylococcal abscess communities (SACs) and canalicular invasion. Novel approaches to target biofilm and increase resistance to implant colonization include novel antibiotic therapy, immunotherapy, and local implant treatments.


Challenges remain given the diverse mechanisms developed by S. aureus to alter the host immune responses. Further understanding of these processes should provide novel therapeutic mechanisms to enhance eradication after PJI.


Prosthetic joint infection Biofilm Staphylococcus aureus 


Compliance with Ethical Standards

Conflict of Interest

Edward M Schwarz reports grants from NIH and AOTrauma during the conduct of the study and personal fees and other from Telephus, LLC, outside the submitted work. In addition, Dr. Schwarz has a patent on passive immunization and diagnostics for S. aureus licensed to Telephus, LLC.

The other authors declare that they have no conflicts of interest.

EMS has patents related to this work. EMS has received financial compensation and stock from Telephus Medical LLC.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Grant Sponsors

National Institutes of Health (EMS), Grant Numbers P30 AR069655 and P50 AR07200 (EMS), and AOTrauma Clinical Priority Program (EMS).


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Benjamin F. Ricciardi
    • 1
  • Gowrishankar Muthukrishnan
    • 1
  • Elysia Masters
    • 1
  • Mark Ninomiya
    • 1
  • Charles C. Lee
    • 1
  • Edward M. Schwarz
    • 1
    Email author
  1. 1.Center for Musculoskeletal Research, Department of OrthopaedicsUniversity of Rochester School of MedicineRochesterUSA

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