Orth Marcel, Orth Patrick, Anagnostakos Konstantinos
Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Kirrberger Strasse 1, 66421 Homburg, Germany.
Department of Orthopedics and Orthopedic Surgery, Saarland University, Kirrberger Strasse 1, 66421 Homburg, Germany.
Knee. 2017 Aug;24(4):876-881. doi: 10.1016/j.knee.2017.04.011. Epub 2017 May 16.
Periprosthetic joint infection (PJI) is a major clinical problem in orthopedic surgery. Capnocytophaga canimorsus (C. canimorsus) is an unusual and hardly detectable bacterium. A review of the literature indicates that C. canimorsus affects mainly immunocompromised patients. It has not been reported to cause periprosthetic joint infections in immunocompetent patients so far. This case report aims to raise awareness of C. canimorsus in orthopedic surgery with special regard to joint arthroplasty.
We report a case of a 54-year-old immunocompetent patient with a late infection after total knee arthroplasty caused by C. canimorsus. The patient underwent two-stage revision with prosthesis explantation, implantation of an antibiotic-impregnated static spacer, intravenous antimicrobial therapy for four weeks with cefuroxime followed by oral antimicrobial therapy with ciprofloxacin for further two weeks and secondary revision total knee arthroplasty.
In the present case, we could demonstrate that adequate treatment of C. canimorsus was capable to successfully treat periprosthetic joint infection caused by C. canimorsus in an immunocompetent patient.
We feel that C. canimorsus has to be taken into account as a potential pathogen causing periprosthetic joint infection - regardless of the immunological status of the patient and especially when the detection of a pathogen does not succeed.
人工关节周围感染（PJI）是骨科手术中的一个主要临床问题。犬咬二氧化碳嗜纤维菌（C. canimorsus）是一种罕见且难以检测到的细菌。文献综述表明，犬咬二氧化碳嗜纤维菌主要影响免疫功能低下的患者。迄今为止，尚未有该菌导致免疫功能正常患者人工关节周围感染的报道。本病例报告旨在提高骨科手术中对犬咬二氧化碳嗜纤维菌的认识，特别是在关节置换方面。
我们报告一例54岁免疫功能正常的患者，在全膝关节置换术后发生由犬咬二氧化碳嗜纤维菌引起的迟发性感染。患者接受了两阶段翻修手术，包括取出假体、植入含抗生素的静态间隔物、静脉注射头孢呋辛进行四周抗菌治疗，随后口服环丙沙星进行两周抗菌治疗，以及二期全膝关节置换翻修手术。
在本病例中，我们证明对犬咬二氧化碳嗜纤维菌进行充分治疗能够成功治疗免疫功能正常患者由该菌引起的人工关节周围感染。
我们认为，无论患者的免疫状态如何，尤其是在未能成功检测到病原体时，犬咬二氧化碳嗜纤维菌都必须被视为引起人工关节周围感染的潜在病原体。
