Late onset periprosthetic joint infection of the knee caused by Streptococcus anginosus. Case presentation and literature review

Abstract

Periprosthetic joint infection (PJI) is one of the most dramatic complications of joint arthroplasty. Although streptococcal bone and joint infections are less common than staphylococcal cases, their role as causative agents of bone and joint remains significant accounting for at least 10% of PJIs. Streptococcus anginosus group (SAG) bacteria are usually found in the normal flora of the urogenital tract, intestinal tract and oropharynx and could cause pyogenic infections to affect brain, lungs and liver. SAG bacteria are uncommonly reported as a cause of osteomyelitis and the involvement of a joint represent a rare event. S. anginosus has been anecdotical related to implant devices infections such as vascular prosthesis or orthopedic implants, however, PJI of the knee has never been fully reported before. We describe the case of a late onset periprosthetic knee infection due to Streptococcus anginosus successfully treated by a two-stage revision arthroplasty and postoperative parenteral Vancomycin, (2 g per day) and Levofloxacin (750 mg per day) for 4 weeks and then oral Levofloxacin for a further 2 weeks.

Late-onset Group B Streptococcus Periprosthetic Joint Infection Cured after Dental Clearance: A Case Report from Barbados and Literature Review

“…Several studies have reported cases of late-onset PJIs caused by oral streptococci, often in the setting of dental procedures or poor oral hygiene [12][13][14]17,18,[21][22][23]. A systematic review by Moreira et al found limited evidence to support the use of antibiotic prophylaxis in patients with periodontitis undergoing joint arthroplasty [6].…”

Prosthetic knee joint infection caused by α-hemolytic Streptococcus species: a case report

“…Marongiu reported a case in which a 72-year-old male had a late onset of PJIs due to Streptococcus anginosus . The infection was treated through two-stage revision arthroplasty and postoperative antibiotic therapy (vancomycin and levofloxacin) [ 18 ]. Several previous studies regarding streptococcal prosthetic joint infections (PJIs) are reviewed and summarized in Table 2 .…”

Model-Informed Precision Dosing of Antibiotics in Osteoarticular Infections

“…19 A patient of periprosthetic knee infection caused by Streptococcus anginosus, was successfully treated by vancomycin (1 g, q12h, iv) and levofloxacin (750 mg, qd, iv) for 4 weeks, and then levofloxacin (750 mg, qd, po) for 2 weeks. 54 In 2020, Eloy et al 55 developed a PPK model of levofloxacin with 59 OAI patients, and the model consisted of a one-compartment model with first-order absorption and elimination. Monte Carlo simulations evaluated the PTA of levofloxacin at a dose of 750 mg, qd, with different ages and renal functions.…”