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Prosthetic hip-joint infection associated with a penicillin-tolerant group B streptococcus
R Cunningham1, C Walker, E Ridgway
1Department of Medical Microbiology, Royal Liverpool University Hospital, U.K.
Abstract:
We report a case of prosthetic hip-joint infection with Streptococcus agalactiae (Lancefield group B streptococcus). The infection recurred after 3 months' treatment with amoxycillin. On further investigation, the isolate was found to be amoxycillin-tolerant. Addition of gentamicin abolished tolerance in vitro and the patient has remained asymptomatic since receiving a 10-day course of amoxycillin and gentamicin followed by amoxycillin alone.
Insights
Prosthetic hip joint infections caused by Streptococcus agalactiae can be challenging. Amoxycillin tolerance in this bacterium necessitates combination therapy, such as amoxycillin with gentamicin, for successful treatment.
Area of Science:
- Infectious Diseases
- Microbiology
- Orthopedic Surgery
Background:
- Prosthetic joint infections (PJIs) pose significant challenges in orthopedic surgery.
- Streptococcus agalactiae, also known as Lancefield group B streptococcus, is an uncommon cause of PJIs.
Observation:
- A case of prosthetic hip-joint infection due to Streptococcus agalactiae is presented.
- The patient experienced a recurrence of infection after initial treatment with amoxycillin.
Findings:
- The infecting Streptococcus agalactiae isolate exhibited amoxycillin tolerance.
- In vitro studies demonstrated that the addition of gentamicin effectively abolished amoxycillin tolerance.
- A treatment regimen combining amoxycillin and gentamicin, followed by amoxycillin alone, resulted in a successful clinical outcome.
Implications:
- This case highlights the importance of considering antibiotic tolerance in recurrent PJIs.
- Combination therapy with amoxycillin and gentamicin may be effective for treating amoxycillin-tolerant Streptococcus agalactiae prosthetic hip-joint infections.
- Further research into the mechanisms of antibiotic tolerance in streptococcal PJIs is warranted.