Staphylococcus aureus Small Colony Variants in Prosthetic Joint Infection
Abstract
BACKGROUND: Small colony variants of Staphylococcus aureus tend to persist despite antimicrobial therapy, especially when involved in implant-associated infections. METHODS: We analyzed 5 cases of hip prosthesis-associated infections due to small colony variants, including their course prior to identification of the pathogen. Biopsy investigations included microbiological examination and, in 1 case, transmission electron microscopy to detect intracellular bacteria in nonprofessional phagocytes. A treatment concept was elaborated on the basis of a published algorithm and patients were managed accordingly. RESULTS: The patients' mean age was 62.2 years. All patients experienced treatment failures prior to isolation of small colony variants, despite as many as 3 surgical revisions and up to 22 months of antibiotics. Transmission electron microscopy performed on biopsy specimens from periprosthetic tissue revealed intracellular cocci in fibroblasts. All prostheses were removed without implanting a spacer, and antimicrobial agents were administered for 5.5-7 weeks. Reimplantation of the prosthesis was performed for 4 patients. Follow-ups were uneventful in all 5 cases. CONCLUSIONS: In the case of a poor response to adequate antimicrobial and surgical treatment in implant-associated staphylococcal infections, small colony variants should be considered and actively sought. In our case series, a 2-stage exchange without implantation of a spacer combined with antimicrobial therapy for an implant-free interval of 6-8 weeks was associated with successful outcome, with a mean follow-up of 24 months.
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This correlates with the clinical evidence that SCVs are able to persist in host tissues, resisting clearance by immune cells that expose the pathogen to the oxidative burst.
“This correlates with the clinical evidence that SCVs are able to persist in host tissues, resisting clearance by immune cells that expose the pathogen to the oxidative burst (1–14, 36, 37).”
From Staphylococcus aureus Adapts to Oxidative Stress by Producing H <sub>2</sub> O <sub>2</sub> -Resistant Small-Colony Variants via the SOS Response (2015) · cites this paper as [10]
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- Authors
- Sendi, P., Rohrbach, M., Graber, P., Frei, R., Ochsner, P. E., & Zimmerli, W.
- Affiliations
- Kantonsspital Baselland (CH)
- University Hospital of Basel (CH)
- Corresponding author
- Sendi, Parham
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-10-15
- Volume
- 43
- Issue
- 8
- Pages
- 961-967
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2137448773
- Cited by
- 232
- References
- 35
- Citations by year
- 2026: 4 · 2025: 15 · 2024: 6 · 2023: 7 · 2022: 15 · 2021: 12 · 2020: 8 · 2019: 12 · 2018: 14 · 2017: 11 · 2016: 9 · 2015: 14 · 2014: 13 · 2013: 15 · 2012: 13
- FWCI
- 14.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- reroDoc Digital Library (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Orthopedic Infections and Treatments
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
- Keywords
- Staphylococcus aureus, small colony variants, periprosthetic joint infection, hip prosthesis, implant-associated infection, intracellular bacteria, fibroblasts, transmission electron microscopy, two-stage revision arthroplasty, antimicrobial therapy, treatment failure
- MeSH terms
- Aged, Anti-Bacterial Agents, Bacterial Proteins, Clinical Protocols, Drug Resistance, Microbial, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Phenotype, Staphylococcus aureus, Prosthesis-Related Infections, Arthroplasty, Replacement, Hip, Device Removal, Microscopy, Electron, Transmission
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