Scientific letter
Peptostreptococcus canis and Bacteroides pyogenes prosthetic joint infection
Infección de prótesis articular por Peptostreptococcus canis y Bacteroides pyogenes
Ana Gual-de-Torrellaa,
, Ana Isabel Suárez-Barrenecheaa, María Dolores del Torob
Corresponding author
a Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain
b Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Macarena/Universidad de Sevilla/Centro Superior de Investigaciones Científicas (CSIC), Sevilla, Spain
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At discharge, she had an eschar on the surgical wound, which is why it started to drain after her stitches were removed. She was readmitted 20 days later with a fever, suppuration and wound dehiscence. The patient was operated on urgently; the wound was cleaned, surgical debridement performed and the polyethylene replaced. Empirical treatment with intravenous vancomycin and ceftazidime was initiated. Four intraoperative samples (osteoarticular biopsy, wound exudate, joint fluid and synovial tissue) and the replaced polyethylene were sent to the microbiological laboratory for culturing.</p><p id="par0010" class="elsevierStylePara elsevierViewall">When the samples were Gram-stained, with the exception of the polyethylene, abundant polymorphonuclear leukocytes and gram-positive cocci were observed. Culturing was done in blood agar, MacConkey agar, Schaedler agar and Schaedler kanamycin–vancomycin agar (Becton Dickinson). The polyethylene was processed using sonication and was cultured in the above media as well as in thioglycollate broth (Becton Dickinson). Turbidity was observed in the broth after 24<span class="elsevierStyleHsp" style=""></span>h and growth in the Schaedler agar and Schaedler kanamycin–vancomycin agar after 48<span class="elsevierStyleHsp" style=""></span>h of incubation in anaerobic conditions. The isolates were identified using mass spectrometry (MALDI-TOF) as <span class="elsevierStyleItalic">P. canis</span> and <span class="elsevierStyleItalic">B. pyogenes</span>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Susceptibility testing was performed with gradient-diffusion strips (E-test, bioMérieux) in Schaedler agar with a reading after 48<span class="elsevierStyleHsp" style=""></span>h of incubation in an anaerobic atmosphere.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> Both isolates were susceptible to penicillin, amoxicillin/clavulanic acid, piperacillin/tazobactam, imipenem, clindamycin and metronidazole. Antibiotic therapy was replaced with parenteral penicillin and, subsequently, rifampicin was introduced. Ten days after the debridement, due to persistent signs of infection, the prosthesis was removed and a gentamicin- and clindamycin-loaded spacer was inserted. Two intraoperative samples (osteoarticular biopsy and joint fluid) and the prosthesis were sent to the laboratory for culturing. Polymorphonuclear leukocytes were observed in the staining of the joint fluid sample. The culture of the samples was negative, except in the sonication fluid of the prosthesis, in which <span class="elsevierStyleItalic">B. pyogenes</span> was isolated. Progress was favourable, with the patient treated with intravenous ampicillin and, at discharge, with oral clindamycin until six weeks of treatment were completed. Six months after the prosthesis was removed, a new prosthesis was re-implanted. Cultures of intraoperative samples were negative.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In our literature review we did not find any reported case of prosthetic joint infection caused jointly by <span class="elsevierStyleItalic">P. canis</span> and <span class="elsevierStyleItalic">B. pyogenes</span>. <span class="elsevierStyleItalic">P. canis</span> is a gram-positive anaerobic coccus found in the subgingival plaque of dogs, while <span class="elsevierStyleItalic">B. pyogenes</span> is a gram-negative anaerobic bacillus found in the oral microbiota of dogs and cats.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,3</span></a> Wound infections caused by contact with animal saliva tend to be polymicrobial and reflect their oral microbiota. Prosthetic joint infection due to these microorganisms is rare. When it does occur, it tends to arise in knee prostheses and be associated with bites, scratches or licks from animals.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> Our patient lived with a dog, although she denied having been bitten or scratched. Contact with a dog in the presence of an open surgical wound supports the aetiology of the infection. Close contact with pets may be a risk that these patients should be warned about.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Prosthetic joint infection caused by anaerobic microorganisms is rare (3–6% of cases), but is associated with significant morbidity and a poor prognosis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> Most are caused by <span class="elsevierStyleItalic">Propionibacterium</span> spp., which is mainly responsible for chronic infections. <span class="elsevierStyleItalic">Peptostreptococcus</span> spp. and <span class="elsevierStyleItalic">Bacteroides</span> spp. are reported less frequently, generally in polymicrobial cultures, and associated with acute, post-operative or haematogenous infections.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> Infections caused by <span class="elsevierStyleItalic">Propionibacterium acnes</span> are more indolent, while those caused by <span class="elsevierStyleItalic">Peptostreptococcus</span> spp. and <span class="elsevierStyleItalic">Bacteroides</span> spp. are associated with greater inflammation and suppuration.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> The aetiological diagnosis is based on proper sample taking and preserving them in anaerobic conditions until they are processed.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> The advance in microbiological diagnostic techniques, such as the use of MALDI-TOF, has allowed these rarely reported microorganisms to be identified with greater precision.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Antibiotic therapy is primarily administered with beta-lactams, in accordance with the antibiogram results. In acute, streptococcal prosthetic joint infections treated with implant retention, the combination of a beta-lactam (or levofloxacin) with rifampicin has been suggested due to its alleged activity against stationary-phase bacteria in biofilms according to the findings of two observational studies, where a better prognosis is described.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">6,7</span></a> However, its <span class="elsevierStyleItalic">in vitro</span> synergy and clinical efficacy in implant-related infections due to anaerobes and streptococci is yet to be demonstrated.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gual-de-Torrella A, Suárez-Barrenechea AI, del Toro MD. Infección de prótesis articular por <span class="elsevierStyleItalic">Peptostreptococcus canis</span> y <span class="elsevierStyleItalic">Bacteroides pyogenes</span>. Enferm Infecc Microbiol Clin. 2019;37:347–348.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antimicrobial resistance and susceptibility testing of anaerobic bacteria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.N. 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Etienne" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12879-015-1330-0" "Revista" => array:6 [ "tituloSerie" => "BMC Infect Dis" "fecha" => "2016" "volumen" => "16" "paginaInicial" => "1" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26729246" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The not-so-good prognosis of streptococcal periprosthetic joint infection managed by implant retention: the results of a large multicenter study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Lora-Tamayo" 1 => "É. Senneville" 2 => "A. Ribera" 3 => "L. Bernard" 4 => "M. Dupon" 5 => "V. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 30 | 5 | 35 |
| 2024 September | 71 | 7 | 78 |
| 2024 August | 69 | 7 | 76 |
| 2024 July | 114 | 10 | 124 |
| 2024 June | 93 | 7 | 100 |
| 2024 May | 92 | 12 | 104 |
| 2024 April | 64 | 16 | 80 |
| 2024 March | 68 | 8 | 76 |
| 2024 February | 65 | 4 | 69 |
| 2024 January | 96 | 3 | 99 |
| 2023 December | 73 | 4 | 77 |
| 2023 November | 81 | 5 | 86 |
| 2023 October | 99 | 4 | 103 |
| 2023 September | 67 | 1 | 68 |
| 2023 August | 67 | 1 | 68 |
| 2023 July | 98 | 4 | 102 |
| 2023 June | 82 | 3 | 85 |
| 2023 May | 120 | 4 | 124 |
| 2023 April | 96 | 3 | 99 |
| 2023 March | 110 | 8 | 118 |
| 2023 February | 64 | 6 | 70 |
| 2023 January | 84 | 2 | 86 |
| 2022 December | 66 | 8 | 74 |
| 2022 November | 88 | 7 | 95 |
| 2022 October | 80 | 7 | 87 |
| 2022 September | 73 | 10 | 83 |
| 2022 August | 77 | 9 | 86 |
| 2022 July | 46 | 5 | 51 |
| 2022 June | 44 | 7 | 51 |
| 2022 May | 33 | 6 | 39 |
| 2022 April | 55 | 7 | 62 |
| 2022 March | 91 | 11 | 102 |
| 2022 February | 78 | 7 | 85 |
| 2022 January | 105 | 9 | 114 |
| 2021 December | 102 | 10 | 112 |
| 2021 November | 93 | 11 | 104 |
| 2021 October | 90 | 15 | 105 |
| 2021 September | 81 | 10 | 91 |
| 2021 August | 91 | 7 | 98 |
| 2021 July | 45 | 15 | 60 |
| 2021 June | 39 | 6 | 45 |
| 2021 May | 58 | 15 | 73 |
| 2021 April | 103 | 9 | 112 |
| 2021 March | 57 | 5 | 62 |
| 2021 February | 25 | 5 | 30 |
| 2021 January | 40 | 15 | 55 |
| 2020 December | 26 | 3 | 29 |
| 2020 November | 40 | 5 | 45 |
| 2020 October | 18 | 5 | 23 |
| 2020 September | 23 | 6 | 29 |
| 2020 August | 28 | 7 | 35 |
| 2020 July | 15 | 2 | 17 |
| 2020 June | 14 | 8 | 22 |
| 2020 May | 18 | 10 | 28 |
| 2020 April | 13 | 7 | 20 |
| 2020 March | 13 | 1 | 14 |
| 2020 February | 29 | 4 | 33 |
| 2020 January | 21 | 5 | 26 |
| 2019 December | 27 | 8 | 35 |
| 2019 November | 7 | 4 | 11 |
| 2019 May | 1 | 0 | 1 |
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