Septic arthritis with Staphylococcus lugdunensis following arthroscopic ACL revision with BPTB allograft.
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.
Orthopedic and Sports Division, Meir University Hospital, Tchernichovsky Street, Kfar-Saba, Israel. omer@extremegate.com
Omer
O
Mei-Dan
Gideon
G
Mann
Gilbert
G
Steinbacher
Soleda J
SJ
Ballester
Ramon Bertomeu
RB
Cugat
Pedro Diaz
PD
Alvarez
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000188:drug therapy / Q000209:etiology*; D001182:Arthroscopy / Q000009:adverse effects; D050376:Bone-Patellar Tendon-Bone Grafting / Q000009:adverse effects*; D002939:Ciprofloxacin / Q000627:therapeutic use; D006801:Humans; D007719:Knee Joint / Q000382:microbiology* / Q000601:surgery; D008297:Male; D012086:Reoperation; D012293:Rifampin / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D013210:Staphylococcus / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology*; D014182:Transplantation, Autologous
D000890:Anti-Infective Agents; D002939:Ciprofloxacin; D012293:Rifampin