Abstract
IntroductionWe report a rare case of an infected revision total knee replacement as a result of a Lactobacillus species infection. Lactobacillus infections have been associated with prolonged broad-spectrum antibiotic use. This can have implications in revision surgery, especially when patients have been on previous long-term suppressive antibiotic therapy.Case presentationAn 81-year-old British man with a previous history of complex revision knee arthroplasty for infection presented with a hot, swollen knee joint. He had previously been on long-term suppressive antibiotic therapy. Aspiration of the knee joint yielded a culture of Lactobacillus species.ConclusionIn patients undergoing revision joint arthroplasty, especially for previous infection, the presence of common and uncommon bacterial species must be excluded and eradicated before further surgical intervention.
Highlights
Introduction: We report a rare case of an infected revision total knee replacement as a result of a Lactobacillus species infection
This can have implications in revision surgery, especially when patients have been on previous long-term suppressive antibiotic therapy
Case presentation: An 81-year-old British man with a previous history of complex revision knee arthroplasty for infection presented with a hot, swollen knee joint
Summary
Lactobacillus is a Gram-positive facultative anaerobic bacterium normally found in the mucosal surfaces of the mouth, the gastrointestinal tract and the genitourinary tract. Case presentation Our patient, an 81-year-old man who had hypertension with peripheral vascular disease, initially underwent a total knee replacement (TKR) for osteoarthritis in 1991. He later had two further revision procedures in the following three years, first for presumed infection ( all culture results were negative) and for component failure. Gram staining identified Gram-positive bacilli in all specimens, which on culture was later confirmed as Lactobacillus paracasei through phenotypic characterisation using the API CH50 biochemical identification kit (BioMérieux). He was treated with intravenous amoxicillin and oral clindamycin.
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