Biofilm formation is associated with poor outcome in prosthetic joint infections caused by Staphylococcus lugdunensis

Background: Staphylococcus lugdunensis has been described as a pathogen of increasing importance in prosthetic joint infections (PJI). Our aim was to describe the clinical presentation of PJI caused by S. lugdunensis, and to correlate the biofilm-forming ability of the bacterial isolates to clinical outcome. Method: S. lugdunensis isolates from PJI episodes during 2015–2019 were included and analysed for biofilm formation using a microtiter plate assay. Medical records from the corresponding patients were reviewed. Results: We identified 36 patients with PJI caused by S. lugdunensis during the study period. Early postoperative PJIs were most frequent (n = 20, 56%). Surgical intervention was performed in a majority of the patients (n = 33, 92%), and the dominating type of antibiotic treatment was a combination of rifampicin and ciprofloxacin (n = 27, 75%). The treatment success-rate was 81% (n = 29). All isolates causing PJI were able to form biofilm in vitro. Biofilm formation was significantly stronger in isolates causing relapsing vs non-relapsing PJI (mean OD₅₅₀ 3.1 ± 0.23 vs 1.14 ± 0.73 p =.001) and strong biofilm formation was also associated with late acute hematogenic PJI (mean OD₅₅₀ 1.8 ± 0.93 vs. 0.93 ± 0.81, p =.01). Conclusion: Strong biofilm production in S. lugdunensis isolates was associated with relapse in PJI.