Archive for February 2, 2014

Relation between mouth and haematogenous infection in total joint replacements.

BMJ. 1994 Aug 20-27;309(6953):506-8.

Bartzokas CA, Johnson R, Jane M, Martin MV, Pearce PK, Saw Y.



To investigate the source of infections associated with orthopaedic prostheses.


Analysis of four infections of prosthetic joints with case records; minimum inhibitory and minimum bactericidal concentrations and sodium dodecylsulphate polyacrylamide gel electrophoresis of the cell wall polypeptides of the Streptococcus sanguis isolates from the mouth and infected prostheses; examination of the patients’ mouths for periodontal disease and caries.


Four adults (three men) aged 58-83.


For each patient the strain of S sanguis isolated from the mouth was indistinguishable from that isolated from the prosthesis. All patients had severe periodontal disease and caries.


The mouth was probably the source of bacterial infection in the prosthetic joints of these patients; the route of infection was possibly haematogenous. Incipient oral infection should be treated before joint replacement, and oral health should be maintained indefinitely.


February 2, 2014 at 9:08 pm

Infections associated with dental procedures in total hip arthroplasty.

J Bone Joint Surg Br. 1999 Jan;81(1):56-9.

LaPorte DM, Waldman BJ, Mont MA, Hungerford DS.


Dental procedures may lead to a transient bacteraemia lasting for up to 30 minutes. Of the numerous cases of total hip arthroplasty (THA) reported which have been infected from haematogenous sources, dental procedures have been involved only infrequently.

We reviewed the records of 2973 patients after THA.  Of the late infections identified in 52 patients, three (6%) were strongly associated with a dental procedure.

Infection was diagnosed by culture from the affected joint;  Streptococcus viridans was identified in two cases and Peptostreptococcus in one.

One patient had diabetes mellitus and another rheumatoid arthritis, both conditions predisposing to infection.

The dental operations all lasted for more than 45 minutes and no patient received perioperative antibiotics.  Infection of a THA after dental procedures is more common than has been previously suspected.

Patients with systemic disease, or who are undergoing extensive procedures, should be considered for prophylactic antibiotic treatment.


February 2, 2014 at 9:06 pm

Analysis of a viridans group strain reveals a case of bacteremia due to lancefield group G alpha-hemolytic Streptococcus dysgalactiae subsp equisimilis in a patient with pyomyositis and reactive arthritis.

J Clin Microbiol. 2003 Feb;41(2):613-8.

Woo PC, Teng JL, Lau SK, Lum PN, Leung KW, Wong KL, Li KW, Lam KC, Yuen KY.


Streptococcus dysgalactiae is classified by a combination of phenotypic and genotypic characteristics into Lancefield group C alpha-hemolytic Streptococcus dysgalactiae subsp. dysgalactiae and Lancefield group C, group G, and group L beta-hemolytic Streptococcus dysgalactiae subsp. equisimilis.

In this study, we report the isolation of a catalase-negative, alpha-hemolytic, optochin- and bacitracin-resistant viridans group strain, which does not grow in 10 or 40% bile, on MacConkey agar or bile esculin agar, or in 6% NaCl, from the blood culture of a 73-year-old woman with pyomyositis and poststreptococcal reactive arthritis.

Lancefield grouping revealed that the strain was a group G streptococcus. The Vitek system (GPI) showed that it was unidentified, and the API system (20 STREP) showed that it was 95.7% S. dysgalactiae subsp. dysgalactiae. 16S rRNA gene sequencing showed that it was a strain of S. dysgalactiae.

Based on phylogenetic affiliation with 16S rRNA gene or GroEL amino acid (another bacterial gene, in addition to 16S rRNA gene, that is highly conserved) sequences, the strain is most closely related to Lancefield group C beta-hemolytic S. dysgalactiae subsp. equisimilis.

PCR amplification and sequencing of the streptolysin S structural gene (sagA) and M protein gene (emm) hypervariable region showed the presence of these suspected primary virulence factors.

Further studies would delineate whether the isolate is just a hemolysin-deficient variant of group G beta-hemolytic S. dysgalactiae subsp. equisimilis or a novel type of S. dysgalactiae.

The present case showed that group G alpha-hemolytic S. dysgalactiae subsp. equisimilis can be associated with serious invasive infection and poststreptococcal sequelae.


February 2, 2014 at 9:04 pm

Treatment of primary isolated shoulder sepsis in the adult patient.

Clin Orthop Relat Res. 2008 Jun 466 (6):1392-6.

Duncan SF, Sperling JW.


Isolated shoulder sepsis is an uncommon clinical problem with little information in the literature on causative organisms and potential sequelae.

We examined the organisms involved, surgical treatments, antibiotic treatments rendered, and complications in these cases.

We retrospectively reviewed the records of 19 adult patients (19 shoulders) who underwent operative treatment of isolated shoulder sepsis from 1996 to 2005.

Patient age, gender, laboratory studies, previous treatment, surgical procedures, surgical findings, cultured organism, antibiotic treatment, and complications were reviewed.

The organisms included methicillin-susceptible Staphylococcus aureus (five), Streptococcus B beta hemolytic (five), Staphylococcus epidermidis (three), negative cultures (two), Streptococcus viridans (one), Escherichia coli (one), methicillin-resistant S. aureus (one), and Propionibacterium acnes (one).

We treated patients with intravenous antibiotics an average of 4.2 weeks (range, 3-8 weeks). One patient underwent humeral head resection with an antibiotic spacer.

Another patient died during hospitalization. Open or arthroscopic débridement in conjunction with appropriate antibiotics appears effective in eradicating infection in most adults who present with shoulder sepsis.

Functional outcome is poor in those patients with irreparable rotator cuff tears and/or cartilage loss.


Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.


February 2, 2014 at 9:01 pm


February 2014

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