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One important criteria to define PJI is the detection of phenotypically indistinguishable microorganisms with identical antibiotic susceptibility pattern in at least two different samples. However, owing to phenotypical variation within genetic clones and clonal variation within a phenotype, the criteria may be ambiguous. We investigated the extent of diversity among coagulase-negative staphylococci (CoNS) in PJI and characterised\n                    <jats:italic>S. epidermidis<\/jats:italic>\n                    isolates from PJI samples, specifically multiple\n                    <jats:italic>S. epidermidis<\/jats:italic>\n                    isolates identified in individual PJI patients. We performed a retrospective cohort study on 62 consecutive patients with PJI caused by CoNS from two hospitals in Northern Sweden. In 16\/62 (26%) PJIs, multiple\n                    <jats:italic>S. epidermidis<\/jats:italic>\n                    isolates were available for whole-genome analyses. Hospital-adapted multidrug-resistant genetic clones of\n                    <jats:italic>S. epidermidis<\/jats:italic>\n                    were identified in samples from 40\/62 (65%) of the patients using a combination of pulsed-field gel electrophoresis and multilocus sequence typing. Whole-genome sequencing showed the presence of multiple sequence types (STs) in 7\/16 (44%) PJIs where multiple\n                    <jats:italic>S. epidermidis<\/jats:italic>\n                    isolates were available. Within-patient phenotypical variation in the antibiotic susceptibility and\/or whole-genome antibiotic resistance gene content was frequent (11\/16, 69%) among isolates with the same ST. The results highlight the ambiguity of\n                    <jats:italic>S. epidermidis<\/jats:italic>\n                    phenotypic characterisation as a diagnostic method in PJI and call for larger systematic studies for determining the frequency of CoNS diversity in PJIs, the implications of such diversity for microbiological diagnostics, and the therapeutic outcomes in patients.\n                  <\/jats:p>","DOI":"10.1007\/s10096-021-04352-w","type":"journal-article","created":{"date-parts":[[2021,10,4]],"date-time":"2021-10-04T11:21:29Z","timestamp":1633346489000},"page":"87-97","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Heterogeneity of Staphylococcus epidermidis in prosthetic joint infections: time to reevaluate microbiological criteria?"],"prefix":"10.1007","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1483-4255","authenticated-orcid":false,"given":"Micael","family":"Widerstr\u00f6m","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Stegger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Johansson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bharat Kumar","family":"Gurram","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders Rhod","family":"Larsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Wallinder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Edebro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tor","family":"Monsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,10,2]]},"reference":[{"issue":"9597","key":"4352_CR1","doi-asserted-by":"publisher","first-page":"1508","DOI":"10.1016\/S0140-6736(07)60457-7","volume":"370","author":"ID Learmonth","year":"2007","unstructured":"Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. 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