Archive for August 9, 2019

Streptococcus salivarius Prosthetic Joint Infection following Dental Cleaning despite Antibiotic Prophylaxis.

Case Rep Infect Dis. April 21, 2019   

Olson LB1, Turner DJ2, Cox GM3, Hostler CJ3,4.

Author information

1 Duke University School of Medicine, Durham, USA.

2 Department of Medicine, Duke University School of Medicine, Durham, USA.

3 Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.

4 Infectious Disease Section, Durham VA Health Care System, Durham, USA.

Abstract

We present the case of a 92-year-old man with septic arthritis of a prosthetic hip joint due to Streptococcus salivarius one week following a high-risk dental procedure despite preprocedure amoxicillin. S. salivarius is a commensal bacterium of the human oral mucosa that is an uncommon cause of bacteremia. S. salivarius has previously been described as a causative agent of infective endocarditis and spontaneous bacterial peritonitis but was only recently recognized as a cause of prosthetic joint infection. This case highlights the potential pathogenicity of a common commensal bacteria and the questionable utility of prophylactic antibiotics before dental procedures to prevent periprosthetic joint infections

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501194/pdf/CRIID2019-8109280.pdf

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August 9, 2019 at 8:26 am

“’The not-so good prognosis of streptococcal periprosthetic joint infection managed by implant retention: the results of a large multicenter study.”

Clinical Infectious Diseases June 15, 2017 V.64 N.12 P.1742–1752

Lora-Tomayo, ´E. Senneville, A. Ribera et al.,

BACKGROUND.

Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success.

METHODS.

A retrospective, observational, multicenter, international study was performed during 2003-2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The primary endpoint was failure, defined as death related to infection, relapse/persistence of infection, or the need for salvage therapy.

RESULTS.

Overall, 462 cases were included (median age 72 years, 50% men). The most frequent species was Streptococcus agalactiae (34%), and 52% of all cases were hematogenous. Antibiotic treatment was primarily using β-lactams, and 37% of patients received rifampin. Outcomes were evaluable in 444 patients: failure occurred in 187 (42.1%; 95% confidence interval, 37.5%-46.7%) after a median of 62 days from debridement; patients without failure were followed up for a median of 802 days. Independent predictors (hazard ratios) of failure were rheumatoid arthritis (2.36), late post-surgical infection (2.20), and bacteremia (1.69). Independent predictors of success were exchange of removable components (0.60), early use of rifampin (0.98 per day of treatment within the first 30 days), and long treatments (≥21 days) with β-lactams, either as monotherapy (0.48) or in combination with rifampin (0.34).

CONCLUSIONS.

This is the largest series to our knowledge of streptococcal PJI managed by DAIR, showing a worse prognosis than previously reported. The beneficial effects of exchanging the removable components and of β-lactams are confirmed and maybe also a potential benefit from adding rifampin.

FULL TEXT

https://academic.oup.com/cid/article/64/12/1742/3078956

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August 9, 2019 at 8:25 am


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