16S rRNA analysis provides evidence of biofilms on all components of three infected periprosthetic knees including permanent braided suture

Abstract

Bacterial biofilms are a 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 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 vs. non-suture material, but did reveal significant differences in organism profile between patients (p < 0.001) and between patients and negative controls (p < 0.001). Confocal microscopy and a novel agar encasement culturing method also confirmed biofilm growth on a subset of components. While16S 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.

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ORCID for Paul Stoodley: orcid.org/0000-0001-6069-273X

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