# Wound infection caused by Staphylococcus arlettae: a case report and metal characterization

## TL;DR

A case of wound infection caused by Staphylococcus arlettae linked to a retained metal fragment is reported, with insights into how different implant materials affect bacterial biofilm formation.

## Contribution

This is the first reported case of S. arlettae causing a wound infection associated with a retained metallic fragment and its biofilm behavior on implant materials.

## Key findings

- S. arlettae was identified as the causative agent of a wound infection linked to a retained metallic fragment.
- In vitro tests showed material-dependent differences in early biofilm formation on SS304, SS316, and TC4.
- The case highlights the importance of implant material selection to reduce infection risks.

## Abstract

Retained metallic foreign bodies can lead to implant-associated wound infections through bacterial colonization and biofilm formation. We report a case of a wound infection associated with a retained metallic fragment caused by Staphylococcus arlettae (S. arlettae) and evaluate the organism’s early biofilm formation on common implant metals.

A 33-year-old man sustained a crush injury to his right hand and forearm, resulting in extensive soft-tissue damage and vascular injury. Emergency surgical management included meticulous debridement and vascular reconstruction. Postoperatively, purulent wound infection was effectively managed following microbiological identification of S. arlettae and antibiotic susceptibility-guided therapy. The treatment regimen involved serial debridement along with stepwise adjustments in antimicrobial dosing. Follow-up revealed that the patient’s hand function had recovered well.

In vitro assays were conducted to compare early bacterial attachment and biofilm formation of the clinical S. arlettae isolate on stainless steel 304 (SS304), stainless steel 316 (SS316), and titanium alloy (TC4). The results revealed material-dependent differences in initial adherence as well as early biofilm development, establishing a link between implant surface properties and bacterial colonization propensity.

This case underscores the clinical significance of retained metallic fragments as potential foci for S. arlettae infection, emphasizing the necessity for prompt debridement, targeted antimicrobial therapy, and consideration of implant material properties. In vitro evidence demonstrating differential biofilm behavior on SS304, SS316, and TC4 has important implications for surgical decision-making, selection of implants, management of wounds, and prophylactic antibiotic strategies aimed at mitigating implant-associated infections.