Quénard Fanny, Seng Piseth, Lagier Jean-Christophe, Fenollar Florence, Stein Andreas
Centre de Référence des Infections Ostéo-Articulaires (CRIOA) Sud-Méditerranée, Assistance Publique - Hôpitaux de Marseille, IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.
Service de Maladies Infectieuses Tropicales et Infections Chroniques (MITIC), IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005, Marseille, France.
BMC Musculoskelet Disord. 2017 Jun 23;18(1):276. doi: 10.1186/s12891-017-1630-1.
Bone and joint infection involving Granulicatella adiacens is rare, and mainly involved in cases of bacteremia and infectious endocarditis. Here we report three cases of prosthetic joint infection involving G. adiacens that were successfully treated with surgery and prolonged antimicrobial treatment. We also review the two cases of prosthetic joint infection involving G. adiacens that are reported in the literature.
Not all five cases of prosthetic joint infection caused by G. adiacens were associated with bacteremia or infectious endocarditis. Dental care before the onset of infection was observed in two cases. The median time delay between arthroplasty implantation and the onset of infection was of 4 years (ranging between 2 and 10 years). One of our cases was identified with 16srRNA gene sequencing, one case with MALDI-TOF mass spectrometry, and one case with both techniques. Two literature cases were diagnosed by 16srRNA gene sequencing. All five cases were cured after surgery including a two-stage prosthesis exchange in three cases, a one-stage prosthesis exchange in one case, and debridement, antibiotics, irrigation, and retention of the prosthesis in one case, and prolonged antimicrobial treatment.
Prosthetic joint infection involving G. adiacens is probably often dismissed due to difficult culture or misdiagnosis, in particular in the cases of polymicrobial infection. Debridement, antibiotics, irrigation, and retention of the prosthesis associated with prolonged antimicrobial treatment (≥ 8 weeks) should be considered as a treatment strategy for prosthetic joint infection involving G. adiacens.
涉及毗邻颗粒链菌的骨与关节感染较为罕见，主要见于菌血症和感染性心内膜炎病例。在此，我们报告3例由毗邻颗粒链菌引起的人工关节感染病例，经手术及延长抗菌治疗后成功治愈。我们还回顾了文献中报道的2例由毗邻颗粒链菌引起的人工关节感染病例。
并非所有5例由毗邻颗粒链菌引起的人工关节感染均与菌血症或感染性心内膜炎相关。2例在感染发作前有牙科治疗史。关节成形术植入与感染发作之间的中位延迟时间为4年（范围在2至10年之间）。我们的病例中1例通过16srRNA基因测序确诊，1例通过基质辅助激光解吸电离飞行时间质谱法确诊，1例通过两种技术确诊。文献中的2例通过16srRNA基因测序确诊。所有5例均在手术后治愈，其中3例行两阶段假体置换，1例行一阶段假体置换，1例行清创、抗生素治疗、冲洗并保留假体，以及延长抗菌治疗。
由于培养困难或误诊，涉及毗邻颗粒链菌的人工关节感染可能常常被漏诊，尤其是在多微生物感染的情况下。清创、抗生素治疗、冲洗并保留假体，同时延长抗菌治疗（≥8周），应被视为涉及毗邻颗粒链菌的人工关节感染的一种治疗策略。
