Mycobacterium smegmatis infection of a prosthetic total knee arthroplasty
The most common organisms causing prosthetic knee joint infections are staphylococci. However, arthroplasty infections with atypical microbial pathogens, such as Mycobacteria can occur. Due to the rarity of mycobacterial prosthetic joint infections, diagnosis, treatment, and management of these atyp...
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| Format: | Article |
| Language: | English |
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Elsevier
2016-01-01
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| Series: | IDCases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214250916300555 |
| _version_ | 1818889289799303168 |
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| author | Zaid Saffo Anthony Ognjan |
| author_facet | Zaid Saffo Anthony Ognjan |
| author_sort | Zaid Saffo |
| collection | DOAJ |
| description | The most common organisms causing prosthetic knee joint infections are staphylococci. However, arthroplasty infections with atypical microbial pathogens, such as Mycobacteria can occur. Due to the rarity of mycobacterial prosthetic joint infections, diagnosis, treatment, and management of these atypical infections represent a clinical challenge. A 71-year old female post-operative day 40 after a left total knee arthroplasty was hospitalized secondary to left knee pain and suspected arthroplasty infection. She had failed outpatient oral antimicrobial treatment for superficial stitch abscess; and outpatient IV/Oral antimicrobials for a clinical postoperative septic bursitis. Ultimately, resection arthroplasty with operative tissue acid fast bacterial cultures demonstrated growth of the Mycobacterium smegmatis group. Post-operatively, she completed a combination course of oral doxycycline and levofloxacin and successfully completed a replacement arthroplasty with clinical and microbial resolution of the infection. To our knowledge, literature review demonstrates three case of knee arthroplasty infection caused by the Mycobacterium smegmatis group. Correspondingly, optimal surgical procedures and antimicrobial management including antimicrobial selection, treatment duration are not well defined. Presently, the best treatment options consists of two step surgical management including prosthesis hardware removal followed by extended antimicrobial therapy, followed by consideration for re-implantation arthroplasty. Our case illustrates importance of considering atypical mycobacterial infections in post-operative arthroplasty infections not responding to traditional surgical manipulations and antimicrobials. For an arthroplasty infection involving the atypical Mycobacterium smegmatis group, two step arthroplasty revision, including arthroplasty resection, with a combination of oral doxycycline and levofloxacin can lead to successful infection resolution, allowing for a successful replacement arthroplasty. |
| first_indexed | 2024-12-19T17:06:40Z |
| format | Article |
| id | doaj.art-dfdac62f4fcf451e9380d1c5918f38ce |
| institution | Directory Open Access Journal |
| issn | 2214-2509 |
| language | English |
| last_indexed | 2024-12-19T17:06:40Z |
| publishDate | 2016-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | IDCases |
| spelling | doaj.art-dfdac62f4fcf451e9380d1c5918f38ce2022-12-21T20:13:09ZengElsevierIDCases2214-25092016-01-015C808210.1016/j.idcr.2016.07.007Mycobacterium smegmatis infection of a prosthetic total knee arthroplastyZaid Saffo0Anthony Ognjan1McLaren Macomb Hospital, Department of Internal Medicine, 1000 Harrington Blvd., Mount Clemens, MI 48043, United StatesMetro Infectious Disease Consultants, McLaren Macomb Hospital, 1000 Harrington Blvd. Mount Clemens, MI 48043, United StatesThe most common organisms causing prosthetic knee joint infections are staphylococci. However, arthroplasty infections with atypical microbial pathogens, such as Mycobacteria can occur. Due to the rarity of mycobacterial prosthetic joint infections, diagnosis, treatment, and management of these atypical infections represent a clinical challenge. A 71-year old female post-operative day 40 after a left total knee arthroplasty was hospitalized secondary to left knee pain and suspected arthroplasty infection. She had failed outpatient oral antimicrobial treatment for superficial stitch abscess; and outpatient IV/Oral antimicrobials for a clinical postoperative septic bursitis. Ultimately, resection arthroplasty with operative tissue acid fast bacterial cultures demonstrated growth of the Mycobacterium smegmatis group. Post-operatively, she completed a combination course of oral doxycycline and levofloxacin and successfully completed a replacement arthroplasty with clinical and microbial resolution of the infection. To our knowledge, literature review demonstrates three case of knee arthroplasty infection caused by the Mycobacterium smegmatis group. Correspondingly, optimal surgical procedures and antimicrobial management including antimicrobial selection, treatment duration are not well defined. Presently, the best treatment options consists of two step surgical management including prosthesis hardware removal followed by extended antimicrobial therapy, followed by consideration for re-implantation arthroplasty. Our case illustrates importance of considering atypical mycobacterial infections in post-operative arthroplasty infections not responding to traditional surgical manipulations and antimicrobials. For an arthroplasty infection involving the atypical Mycobacterium smegmatis group, two step arthroplasty revision, including arthroplasty resection, with a combination of oral doxycycline and levofloxacin can lead to successful infection resolution, allowing for a successful replacement arthroplasty.http://www.sciencedirect.com/science/article/pii/S2214250916300555AtypicalMycobacteriumSmegmatisProstheticArthroplastyInfection |
| spellingShingle | Zaid Saffo Anthony Ognjan Mycobacterium smegmatis infection of a prosthetic total knee arthroplasty IDCases Atypical Mycobacterium Smegmatis Prosthetic Arthroplasty Infection |
| title | Mycobacterium smegmatis infection of a prosthetic total knee arthroplasty |
| title_full | Mycobacterium smegmatis infection of a prosthetic total knee arthroplasty |
| title_fullStr | Mycobacterium smegmatis infection of a prosthetic total knee arthroplasty |
| title_full_unstemmed | Mycobacterium smegmatis infection of a prosthetic total knee arthroplasty |
| title_short | Mycobacterium smegmatis infection of a prosthetic total knee arthroplasty |
| title_sort | mycobacterium smegmatis infection of a prosthetic total knee arthroplasty |
| topic | Atypical Mycobacterium Smegmatis Prosthetic Arthroplasty Infection |
| url | http://www.sciencedirect.com/science/article/pii/S2214250916300555 |
| work_keys_str_mv | AT zaidsaffo mycobacteriumsmegmatisinfectionofaprosthetictotalkneearthroplasty AT anthonyognjan mycobacteriumsmegmatisinfectionofaprosthetictotalkneearthroplasty |