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Group B streptococcal prosthetic joint infections: a retrospective study of 30 cases
Valérie Zeller1, Marina Lavigne, Philippe Leclerc
1Service d'Orthopédie et de Traumatologie Groupe Hospitalier Diaconesses-Croix Saint-Simon, F-75020 Paris, France. vzeller@hopital-dcss.org
Objective:
To describe the epidemiological, clinical, and laboratory characteristics of patients with group B streptococcal (GBS) prosthetic joint infections, their diagnoses, treatment, and long-term outcomes.
Methods:
We conducted a retrospective cohort study including all patients hospitalized from January 1994 through May 2006 for a GBS prosthetic joint infection.
Results:
The study included 30 patients, aged 35-87 (median 74) years with prosthetic hip (24) or knee (6) infections, 20 with at least one underlying disease. The route of infection was presumed to be hematogenous in 27 patients, and a portal of entry was identified in 9 (genitourinary tract 4, skin 2, gastrointestinal tract 2, oropharynx 1). All patients underwent surgery (6 debridement-synovectomy, 9 1-stage exchange arthroplasty, 8 2-stage exchange arthroplasty, 6 hip resection arthroplasty, and 1 knee arthrodesis) and received prolonged intravenous antibiotics. Four patients relapsed. One patient developed 2 other infections on her knee prosthesis. Two deaths were infection-related, and one was treatment-related. Nineteen patients followed for >/=2 years were cured. One patient was lost to follow-up and 3 died of causes unrelated to infection or treatment within 2 years.
Conclusion:
GBS prosthetic joint infections are mostly acute hematogenous infections that require prompt management for satisfactory outcome. Despite high antibiotic susceptibility, treatment failure is frequent because of the severity of the infection and patients' advanced age, underlying diseases, and relapses.
Insights
Group B streptococcal (GBS) prosthetic joint infections are often acute hematogenous cases requiring prompt treatment. Despite antibiotic susceptibility, treatment failure is common due to infection severity and patient factors.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Microbiology
Background:
- Prosthetic joint infections (PJIs) pose significant challenges in orthopedic surgery.
- Group B streptococcal (GBS) infections are less common but can lead to severe outcomes in PJI cases.
Purpose of the Study:
- To characterize epidemiological, clinical, and laboratory features of GBS prosthetic joint infections.
- To evaluate the diagnosis, treatment, and long-term outcomes of these infections.
Main Methods:
- Retrospective cohort study of patients hospitalized with GBS PJI between January 1994 and May 2006.
- Analysis of patient demographics, infection sources, surgical interventions, antibiotic treatments, and follow-up data.
Main Results:
- Thirty patients (median age 74) with hip or knee GBS PJI were included; 20 had comorbidities.
- Hematogenous spread was the presumed route in 27 patients; surgical management and prolonged antibiotics were standard.
- Four patients relapsed, and 19 patients achieved cure after >/=2 years of follow-up.
Conclusions:
- GBS PJIs are typically acute hematogenous infections necessitating rapid management for optimal outcomes.
- Treatment failure is frequent due to infection severity, patient comorbidities, advanced age, and potential relapses, despite GBS's antibiotic susceptibility.
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