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Background    Staphylococcus epidermidis  orthopedic device infections are caused by direct inoculation of commensal flora during surgery and remain rare, although  S. epidermidis  carriage is likely universal. We wondered whether  S. epidermidis  orthopedic device infection strains might constitute a sub-population of commensal isolates with specific virulence ability. Biofilm formation and invasion of osteoblasts by  S. aureus  contribute to bone and joint infection recurrence by protecting bacteria from the host-immune system and most antibiotics. We aimed to determine whether  S. epidermidis  orthopedic device infection isolates could be distinguished from commensal strains by their ability to invade osteoblasts and form biofilms.    Materials and Methods  Orthopedic device infection  S. epidermidis  strains (n = 15) were compared to nasal carriage isolates (n = 22). Osteoblast invasion was evaluated in an  ex vivo  infection model using MG63 osteoblastic cells co-cultured for 2 hours with bacteria. Adhesion of  S. epidermidis  to osteoblasts was explored by a flow cytometric approach, and internalized bacteria were quantified by plating cell lysates after selective killing of extra-cellular bacteria with gentamicin. Early and mature biofilm formations were evaluated by a crystal violet microtitration plate assay and the Biofilm Ring Test method.    Results  No difference was observed between commensal and infective strains in their ability to invade osteoblasts (internalization rate 308+/−631 and 347+/−431 CFU/well, respectively). This low internalization rate correlated with a low ability to adhere to osteoblasts. No difference was observed for biofilm formation between the two groups.    Conclusion  Osteoblast invasion and biofilm formation levels failed to distinguish  S. epidermidis  orthopedic device infection strains from commensal isolates. This study provides the first assessment of the interaction between  S. epidermidis  strains isolated from orthopedic device infections and osteoblasts, and suggests that bone cell invasion is not a major pathophysiological mechanism in  S. epidermidis  orthopedic device infections, contrary to what is observed for  S. aureus .

Staphylococcus epidermidis in Orthopedic Device Infections: The Role of Bacterial Internalization in Human Osteoblasts and Biofilm Formation