J Bone Jt Infect 2020; 5(1):1-6. doi:10.7150/jbji.36923

Research Paper

Streptococcus bovis Hip and Knee Periprosthetic Joint Infections: A Series of 9 Cases

Jeremy C. Thompson1, Ashton H. Goldman1, Aaron J. Tande2, Douglas R. Osmon1,2, Rafael J. Sierra1✉

1. Department of Orthopedic Surgery
2. Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN.

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Thompson JC, Goldman AH, Tande AJ, Osmon DR, Sierra RJ. Streptococcus bovis Hip and Knee Periprosthetic Joint Infections: A Series of 9 Cases. J Bone Jt Infect 2020; 5(1):1-6. doi:10.7150/jbji.36923. Available from http://www.jbji.net/v05p0001.htm

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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.