Prosthetic Knee Joint Infection Caused by α-hemolytic Streptococcus Species

A Case Report

Masoud Mardani; Jafar Mohammadshahi; Roghayeh Teimourpour

J Med Case Reports. 2023;17(339)

Abstract and Introduction

Abstract

Background: Knee arthroplasty is an orthopedic surgical procedure in which a damaged joint is replaced with an artificial one. It is estimated that 1–2% of knee arthroplasties will encounter infection over their lifetime. Although α-hemolytic Streptococcus species play an important role in prosthetic joint infection, they are less common than staphylococcal species.

Case Presentation: In this report, a 50-year-old Iranian woman was diagnosed with prosthetic knee joint infection based on clinical, radiological, and laboratory findings. She was diabetic and had undergone a left total knee arthroplasty, which, 18 months after the surgery, presented pain, erythema, and edema in that knee. The primary culture of knee aspirate was positive for α-hemolytic Streptococcus species, but following antibiotic medication, culture was negative. The primary antibiotic regime was vancomycin and meropenem, which was changed to cefepime for the management of the infection based on the results of antimicrobial susceptibility testing.

Conclusions: This report indicated the clinical presentation and management of the patient with prosthetic joint infection in which the patient recovered without any severe complications or surgical intervention.

1 2 3 4

Next Section

Table 1. Laboratory findings of patient on hospital admission
Lab study type	Variable	Lab value	Reference range
Blood	WBC	12.6 (× 10³ per μl)	4.5–11 (× 10³ per μl)
	Hb	11.4	14–16.5 g/dl
	Blood sugar	224	70–140 mg/dl
	Urea	38	10.6–48.5 mg/dl
	Cr	1	0.7–1.4 mg/dl
	ESR	80	0–30 mm/hour
	CRP	278	0–10 mg/l
	PLT	172	150–440(× 10³ per μl)
Synovial fluid	WBC	many	MN = 10%, PMN = 90%
	RBC	1500 cell/ml

Hb hemoglobin, WBC white blood cell, ESR erythrocyte sedimentation rate, CRP Creactive protein, Cr creatinine, RBC Red blood cell, PLT platelet cell, MN mononuclear, PMN polymorphonuclear

Table 2. Summary of some previous streptococcal prosthetic joint infections
	Type of study	Age	Reported comorbidity	The most effective antibiotics	Year
Fiaux et al. [17]	Retrospective	69.1 ± 13.7	Diabetes mellitus 35.6%, rheumatoid polyarthritis 9.1%, chronic renal disease 14.9%, chronic liver disease 10.3%, malnutrition 28.7%, neoplasia 8%, corticosteroids 12.6%	Rifampicin-levofloxacin	2001–2009
Marongiu [18]	Case report	72	Hypertension, urinary tract infection	Vancomycin, levofloxacin	2019
Huotari [23]	Retrospective	66.4 ± 12.3	Rheumatoid arthritis, immunosuppressive medication, renal failure	Amoxicillin, clindamycin, and cephalexin; rifampin	2008–2017
Tamayo [24]	Retrospective	Mean age: 72	Malignancy	β-Lactams, rifampin	2003–2012
Mahieu [25]	Retrospective	77	Diabetes, chronic arterial hypertension, chronic heart failure, chronic obstructive pulmonary disease, alcohol abuse, rheumatoid arthritis, chronic renal failure, active cancer, cirrhosis	Amoxicillin, levofloxacin, rifampicin	2010–2012
Akgün [26]	Retrospective	71	–	Rifampin, penicillin, levofloxacin, clindamycin, co-trimoxazole	2009–2015
Lam [27]	Retrospective	70	–	Amoxicillin, penicillin V, clindamycin, rifampicin	2011–2015
Balato [6]	Case report	22	Obesity	Piperacillin/tazobactam, amoxicillin, clindamycin	2019
Olson [28]	Case report	92	Dental procedure	Piperacillin-tazobactam, vancomycin	2019