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Abstract
Introduction: Prosthetic joint infection (PJI) due to Streptococcus bovis group (SBG), specifically S. bovis biotype I (S. gallolyticus), is rare and associated with colorectal carcinoma. Little has been published regarding SBG PJI. We analyzed nine cases of SBG PJI at our institution, the largest series to date.Methods: The medical records of patients diagnosed with SBG PJI between 2000-2017 were reviewed. Patients were followed until death, failure, or loss to follow-up. Mean follow-up was 37 months (range 0.5-74 months).Results: Nine PJI in 8 patients with mean prosthesis age at diagnosis of 8 years (range 4 weeks-17 years) were identified. The median duration between symptom onset and treatment was 38 weeks (range 0.3 weeks-175 weeks). 8/9 had their PJI eradicated with treatment based on acuity of symptoms. Acute PJI (2) was treated with DAIR, and chronic PJI (7) was treated with 2-stage revision arthroplasty. 1 PJI with chronic PJI developed recurrent infection after initial treatment. All patients received post-operative IV antibiotics. 7/8 patients received Ceftriaxone. Three patients received lifelong oral antibiotics. 7/8 patients underwent colonoscopy. 5/7 patients were found to have polyps following PJI diagnosis with one carcinoma and two dysplastic polyps. The two patients without polyps had identifiable gastrointestinal (GI) mucosal abnormality: tooth extraction prior to symptom onset and diverticulosis on chronic anticoagulation.Conclusion: SBG PJI is typically due to hematologic seeding. Colonoscopy should be pursued for patients with SBG PJI. Surgical treatment dictated by infection acuity and 6-week course of Ceftriaxone seems sufficient to control infection.
Highlights
Prosthetic joint infection (PJI) due to Streptococcus bovis group (SBG), S. bovis biotype I (S. gallolyticus), is rare and associated with colorectal carcinoma
The purpose of this paper is to report one institution’s experience with SBG PJI and answer the following questions: 1. what is the proportion of SBG PJI to all PJI, (2) what is the relationship between SBG PJI and any potential sources including colonic/rectal malignancy, and (3) what are the outcomes of surgically treated SBG PJIs
After IRB approval (IRB # 18-000453, 2/8/2018), we identified all cases of SBG PJI from our institutional PJI registry that includes all hip and knee PJI diagnosed and/or treated at our institution
Summary
Prosthetic joint infection (PJI) due to Streptococcus bovis group (SBG), S. bovis biotype I (S. gallolyticus), is rare and associated with colorectal carcinoma. Little has been published regarding SBG PJI. Periprosthetic joint infection (PJI) is a major complication with an incidence of 0.3% to 4% after primary total hip arthroplasty (THA) and 0.4% to 3.9% for primary total knee arthroplasty (TKA) [1,2,3,4,5,6]. The Streptococcus bovis group (SBG) is an uncommon cause of PJI. Previous reports have shown a strong association between SBG bacteremia and concomitant colorectal carcinoma [10, 11]. With the development of more refined identification methods, the nomenclature and disease associations of SBG have been updated to show association between S. bovis biotype I Little has been published regarding SBG septic arthritis, and even less has been reported regarding http://www.jbji.net
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