Adaptive antimicrobial resistance - description of microbial variants & their relevance in PJI: a review

Abstract

Periprosthetic joint infection (PJI) is a difficult complication requiring an aggressive eradication protocol. Treatment cure rates remain essentially stalled in the last two decades utilizing methods of antimicrobial cement joint spacers and parenteral antimicrobial agents. Functional spacers with higher dose antimicrobial loaded cement and antimicrobial loaded CaSO4 beads have emphasized local antimicrobial delivery with the premise that high dose local antimicrobial delivery will positively impact eradication. However, with increasing antimicrobial pressures, microbiota have responded with adaptive mechanisms beyond traditional antimicrobial resistance genes. For this discussion 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 physicians and specialist alike regarding 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.

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

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