|
The most serious complication of joint prosthesis is infection with an incidence of 1.5-2.5% for primary interventions and up to 20% for revision procedures. Staphylococci are the most frequently isolated organism at all time points: early, delayed and late. CoNS account for most of these (30%-41%) with S. aureus as the second most common (12%-39%). Late infections ar presumed to be of haematogenous aetiology and S. aureus seems to predominate at this point. Streptococci, enterococci and diphtheroids each account for around 10% of cases. Gram-negative organisms are much less common than Gram-positive, causing around 8% of cases. Little is known about group B streptococcus (GBS) in periprosthetic joint infections. Recently, however, the incidence of invasive GBS infections in non-pregnant adults is increasing. The median frequency of GBS prosthetic joint infection was around 3%. GBS prosthetic joint infections commonly occurs in patients with several comorbidities and often presents with acute symptoms and damaged periprosthetic soft tissue. Also, infection frequently presents ≥3 months after implantation, indicating a predominantly haematogenous route. The most common clinical presentation of invasive GBS infections reported was bacteremia without focus, followed by skin and/or soft tissue infection and pneumonia. Outcome of GBS prosthetic joint infections is good. The optimal treatment strategy for GBS prosthetic joint infection is unknown. Penicillin is the antimicrobial agent of choice of GBS infection. Debridement with retention of the implant can be successfully performed if the duration of symptoms is short, the implant stable, and the tissue damage minor.
<Reference>
1. Prosthetic joint infections: microbiology, diagnosis, management and prevention. International Journal of Antimicrobial Agents. 2008;32:287-293
2. The diagnosis and management of prosthetic joint infections. Journal of Antimicrobial Chemotherapy. 2010;65 suppl 3:iii45-54
3. Increasing Burden of Invasive Group B Streptococcal Disease in Nonpregnant Adults, 1990-2007. Clinical Infectious Diseases. 2009;49:85-92
4. Invasive Group B streptococcal Disease in the Elderly, Minnesota, USA, 2003-2007. Emerging Infectious Diseases. 2009;15:1279-1281
5. Group B streptococcus in prosthetic hip and knee joint-associated infections. Journal of Hospital Infection. 2011;79:64-69
|
