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Direct Demonstration of Viable Staphylococcus aureus Biofilms in an Infected Total Joint ArthroplastyA Case Report
Paul Stoodley, PhD1; Laura Nistico, PhD1; Sandra Johnson, BS1; Leslie-Ann Lasko, PA-C1; Mark Baratz, MD1; Vikram Gahlot, MD1; Garth D. Ehrlich, PhD1; Sandeep Kathju, MD, PhD1
1 Center for Genomic Sciences, Allegheny-Singer Research Institute, (P.S., L.N., S.J., L.-A.L., M.B., V.G., G.D.E., and S.K.) and the Department of Microbiology and Immunology, Drexel University College of Medicine (Allegheny Campus) (P.S., G.D.E., and S.K.), Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212-4772. E-mail address for S. Kathju: skathju@wpahs.org
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the NIH: NIDCD and NIDCR (K08 DE014780, SK), Allegheny-Singer Research Institute, HRSA C76HF06163 (GDE), DC 04173 (GDE), RO1 DC005659 (JCP). In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits of less than $10,000 or a commitment or agreement to provide such benefits from commercial entities (Stryker and Medtronics). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Center for Genomic Sciences, Allegheny-Singer Research Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Aug 01;90(8):1751-1758. doi: 10.2106/JBJS.G.00838
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Infection following total joint arthroplasty is difficult to diagnose and treat; a nascent body of evidence from studies of prosthetic joint infections suggests that biofilm bacteria are the underlying cause1-3. We describe the case of a patient who had chronic recurring symptoms of infection that persisted for years following total elbow arthroplasty despite numerous medical and surgical interventions. Confocal microscopy performed on fluid, tissue, and cement at the final surgical revision demonstrated viable bacteria in biofilm aggregates. Reverse transcriptase-polymerase chain reaction analysis confirmed the presence of metabolically active Staphylococcus aureus. These observations comprise compelling evidence that viable biofilm bacteria play an important role in refractory infection following joint arthroplasty.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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