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Septic arthritis with Staphylococcus lugdunensis following arthroscopic ACL revision with BPTB allograft

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Septic arthritis following anterior cruciate ligament reconstruction is an uncommon but a serious complication resulting in six times greater hospital costs than that of uncomplicated ACL surgery and an inferior postoperative activity level. Promptly initiating a specific antibiotic therapy is the most critical treatment, followed by open or arthroscopic joint decompression, debridement and lavage. Staphylococcus lugdunensis is a coagulase-negative staphylococcus predominantly infecting the skin and soft tissue. The few reported cases of bone and joint infections by S. lugdunensis indicate that the clinical manifestations were severe, the diagnosis elusive, and the treatment difficult. If the microbiology laboratory does not use the tube coagulase (long) test to confirm the slide coagulase test result, the organism might be misidentified as Staphylococcus aureus. S. lugdunensis is more virulent than other coagulase-negative staphylococcus; in many clinical situations it behaves like S. aureus, further increasing the confusion and worsening the expected outcome. S. lugdunensis is known to cause infective endocarditis with a worse outcome, septicemia, deep tissue infection, vascular and joint prosthesis infection, osteomyelitis, discitis, breast abscess, urine tract infections, toxic shock and osteitis pubis. We present the first case report in the literature of septic arthritis with S. lugdunensis following arthroscopic ACL revision with bone–patellar–tendon–bone allograft.

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References

  1. Anguera I, Del Rio A, Miro JM et al (2005) Hospital Clinic Endocarditis Study Group. Staphylococcus lugdunensis infective endocarditis: description of 10 cases and analysis of native valve, prosthetic valve, and pacemaker lead endocarditis clinical profiles. Heart 91(2):e10

    Article  PubMed  CAS  Google Scholar 

  2. Arciola CR, Campoccia D, An YH et al (2006) Prevalence and antibiotic resistance of 15 minor staphylococcal species colonizing orthopedic implants. Int J Artif Organs 29(4):395–401

    PubMed  CAS  Google Scholar 

  3. Armstrong RW, Bolding F, Joseph R (1992) Septic arthritis following arthroscopy: clinical syndromes and analysis of risk factors. Arthroscopy 8(2):213–223

    Article  PubMed  CAS  Google Scholar 

  4. Blasco-Navalpotro MA, Campos C, Soto M, Romero A (2003) [Toxic shock due to Staphylococcus lugdunensis]. Enferm Infecc Microbiol Clin 21(2):116–117

    Article  PubMed  Google Scholar 

  5. Camacho M, Guis S, Mattei JP, Costello R, Roudier J (2002) Three-year outcome in a patient with Staphylococcus lugdunensis discitis. Joint Bone Spine 69(1):85–87

    Article  PubMed  Google Scholar 

  6. Casanova-Roman M, Sanchez-Porto A (2004) Casanova-Bellido M.Urinary tract infection due to Staphylococcus lugdunensis in a healthy child. Scand J Infect Dis 36(2):149–150

    Article  PubMed  Google Scholar 

  7. Centers for disease control and prevention (CDC) (2001) Septic arthritis following anterior cruciate ligament reconstruction using tendon allografts—Florida and Louisiana, 2000. MMWR Morb Mortal Wkly Rep 50(48):1081–1083

    Google Scholar 

  8. Fong SY, Tan JL (2004) Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Ann Acad Med Singap 33(2):228–234

    PubMed  CAS  Google Scholar 

  9. Hellbacher C, Tornqvist E, Soderquist B (2006) Staphylococcus lugdunensis: clinical spectrum, antibiotic susceptibility, and phenotypic and genotypic patterns of 39 isolates. Clin Microbiol Infect 12(1):43–49

    Article  PubMed  CAS  Google Scholar 

  10. Herchline TE, Ayers LW (1991) Occurrence of Staphylococcus lugdunensis in consecutive clinical cultures and relationship of isolation to infection. J Clin Microbiol 29:419–421

    PubMed  CAS  Google Scholar 

  11. Indelli PF, Dillingham M, Fanton G, Schurman DJ (2002) Septic arthritis in postoperative anterior cruciate ligament reconstruction. Clin Orthop Relat Res 398:182–188

    Article  PubMed  Google Scholar 

  12. Judd MA, Bottoni LT, Kim D, Burke CP, Hooker MA (2006) Infections following arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 22(4):375–384

    Article  PubMed  Google Scholar 

  13. Margheritini F, Camillieri G, Mancini L, Mariani PP (2001) C-reactive protein and erythrocyte sedimentation rate changes following arthroscopically assisted anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 9(6):343–345

    Article  PubMed  CAS  Google Scholar 

  14. Matava MJ, Evans TA, Wright RW, Shively RA (1998) Septic arthritis of the knee following anterior cruciate ligament reconstruction: results of a survey of sports medicine fellowship directors. Arthroscopy 14(7):717–725

    Article  PubMed  CAS  Google Scholar 

  15. McAllister DR, Parker RD, Cooper AE, Recht MP, Abate J (1999) Outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction. Am J Sports Med 27(5):562–570

    PubMed  CAS  Google Scholar 

  16. Nightingale J (1987) Clinical limitations of in vitro testing of microorganism susceptibility. Am J Hosp Pharm 44(1):131–7

    PubMed  CAS  Google Scholar 

  17. Nin JR, Leyes M, Schweitzer D (1996) Anterior cruciate ligament reconstruction with fresh-frozen patellar tendon allografts: sixty cases with 2 years’ minimum follow-up. Knee Surg Sports Traumatol Arthrosc 4(3):137–142

    Article  PubMed  Google Scholar 

  18. Peterson RK, Shelton WR, Bomboy AL (2001) Allograft versus autograft patellar tendon anterior cruciate ligament reconstruction: a 5-year follow-up. Arthroscopy 17(1):9–13

    Article  PubMed  CAS  Google Scholar 

  19. Ruiz L, Corbella X, Agullo JL, Verdaguer R, Cabo X (1998) [Pubic osteitis caused by Staphylococcus lugdunensis]. Enferm Infecc Microbiol Clin 16(3):152–153

    PubMed  Google Scholar 

  20. Sadovsky P, Musil D, Stehlik J (2005) [Allograft for surgical reconstruction of the cruciate ligaments of the knee—part 1]. Acta Chir Orthop Traumatol Cech 72(5):293–296

    PubMed  Google Scholar 

  21. Sanchez P, Buezas V, Maestre JR (2001) [Staphylococcus lugdunensis infection: Report of thirteen cases]. Enferm Infecc Microbiol Clin 19(10):475–478 (Spanish)

    PubMed  CAS  Google Scholar 

  22. Sampathkumar P, Osmon DR, Cockerill FR 3rd (2000) Prosthetic joint infection due to Staphylococcus lugdunensis. Mayo Clin Proc 75(5):511–512

    Article  PubMed  CAS  Google Scholar 

  23. Schollin-Borg M, Michaelsson K, Rahme Harthroscopy (2003) Presentation, outcome, and cause of septic arthritis after anterior cruciate ligament reconstruction: a case control study. Arthroscopy 19(9):941–947

    Article  PubMed  Google Scholar 

  24. Sivadon V, Rottman M, Chaverot S et al (2005) Use of genotypic identification by sodA sequencing in a prospective study to examine the distribution of coagulase-negative Staphylococcus species among strains recovered during septic orthopedic surgery and evaluate their significance. J Clin Microbiol 43(6):2952–2954

    Article  PubMed  Google Scholar 

  25. Vachal J, Kriz J, Jehlicka D, Novak P (2005) Infectious complications after arthroscopic replacement of the cruciate ligaments. Acta Chir Orthop Traumatol Cech 72(1):28–31

    PubMed  CAS  Google Scholar 

  26. Viola R, Marzano N, Vianello R (2000) An unusual epidemic of Staphylococcus-negative infections involving anterior cruciate ligament reconstruction with salvage of the graft and function. Arthroscopy 16(2):173–177

    Article  PubMed  Google Scholar 

  27. Vukadinovic MV, Brustulov D, Car B, Prohaska-Potocnik C (2002) [Detection of Staphylococcus lugdunensis in clinical specimens and their sensitivity to antimicrobial agents]. Lijec Vjesn 124(5):134–136 (Croatian)

    PubMed  Google Scholar 

  28. Williams RJ 3rd, Laurencin CT, Warren RF, Speciale AC, Brause BD, O’Brien S (1997) Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Diagnosis and management. Am J Sports Med 25(2):261–267

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Orthopedic and Sports Division, Meir University Hospital, Tchernichovsky Street, Kfar-Saba, Israel

    Omer Mei-Dan & Gideon Mann

  2. Mutualidad de futbolistas Españoles, Delegación Catalana, Barcelona, Spain

    Omer Mei-Dan, Gilbert Steinbacher, Ramon Bertomeu Cugat & Pedro Diaz Alvarez

  3. Hospital del Mar, IMAS, Barcelona, Spain

    Soleda J. Ballester

  4. Clinica Quirón, Barcelona, Spain

    Pedro Diaz Alvarez

Authors
  1. Omer Mei-Dan
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  2. Gideon Mann
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  3. Gilbert Steinbacher
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  4. Soleda J. Ballester
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  5. Ramon Bertomeu Cugat
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  6. Pedro Diaz Alvarez
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Correspondence to Omer Mei-Dan.

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Mei-Dan, O., Mann, G., Steinbacher, G. et al. Septic arthritis with Staphylococcus lugdunensis following arthroscopic ACL revision with BPTB allograft. Knee Surg Sports Traumatol Arthr 16, 15–18 (2008). https://doi.org/10.1007/s00167-007-0379-8

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  • DOI: https://doi.org/10.1007/s00167-007-0379-8

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