Adaptive antimicrobial resistance, a description of microbial variants, and their relevance to periprosthetic joint infection. (2nd May 2022)

• Record Type: Journal Article
• Authors: Hamad, Christopher; Chowdhry, Madhav; Sindeldecker, Devin; Bernthal, Nicholas M.; Stoodley, Paul; McPherson, Edward J.
• Is Part Of: Bone & joint journal. Volume 104B:Number 5(2022)
• Page Start: 575
• Page End: 580
• Publication Date: 2022-05-02
• Subjects: Microbial variants -- Periprosthetic joint infection -- PJI -- Transient hypermutability -- Small colony variants -- Persister cells -- Adaptive resistance -- Transient antimicrobial resistance -- Phoenix colonies -- Variant selection -- Periprosthetic joint infection (PJI) -- antimicrobial agents -- calcium sulphate -- calcium sulphate -- clinicians -- biofilms -- organism(s) -- antibiotic -- surgical debridement -- toxin; Bones -- Surgery -- Periodicals; Joints -- Surgery -- Periodicals; Orthopedic surgery -- Periodicals; 617.47005
• DOI: 10.1302/0301-620X.104B5.BJJ-2021-1759.R1
• Languages: English
• ISSNs: 2049-4394

Abstract

Abstract : Periprosthetic joint infection (PJI) is a difficult complication requiring a comprehensive eradication protocol. Cure rates have essentially stalled in the last two decades, using methods of antimicrobial cement joint spacers and parenteral antimicrobial agents. Functional spacers with higher-dose antimicrobial-loaded cement and antimicrobial-loaded calcium sulphate beads have emphasized local antimicrobial delivery on the premise that high-dose local antimicrobial delivery will enhance eradication. However, with increasing antimicrobial pressures, microbiota have responded with adaptive mechanisms beyond traditional antimicrobial resistance genes. In this review we describe adaptive resistance mechanisms that are relevant to the treatment of PJI. Some mechanisms are well known, but others are new. The objective of this review is to inform clinicians of the known adaptive resistance mechanisms of microbes relevant to PJI. We also discuss the implications of these adaptive mechanisms in the future treatment of PJI. Cite this article: Bone Joint J 2022;104-B(5):575–580.