title: Group B streptococcal prosthetic joint infections: a retrospective study of 30 cases.
abstract: OBJECTIVE
  To describe the epidemiological, clinical, and laboratory characteristics of patients with group B streptococcal (GBS) prosthetic joint infections, their diagnoses, treatment, and long-term outcomes.
  
  
  METHODS
  We conducted a retrospective cohort study including all patients hospitalized from January 1994 through May 2006 for a GBS prosthetic joint infection.
  
  
  RESULTS
  The study included 30 patients, aged 35-87 (median 74) years with prosthetic hip (24) or knee (6) infections, 20 with at least one underlying disease. The route of infection was presumed to be hematogenous in 27 patients, and a portal of entry was identified in 9 (genitourinary tract 4, skin 2, gastrointestinal tract 2, oropharynx 1). All patients underwent surgery (6 debridement-synovectomy, 9 1-stage exchange arthroplasty, 8 2-stage exchange arthroplasty, 6 hip resection arthroplasty, and 1 knee arthrodesis) and received prolonged intravenous antibiotics. Four patients relapsed. One patient developed 2 other infections on her knee prosthesis. Two deaths were infection-related, and one was treatment-related. Nineteen patients followed for >/=2 years were cured. One patient was lost to follow-up and 3 died of causes unrelated to infection or treatment within 2 years.
  
  
  CONCLUSIONS
  GBS prosthetic joint infections are mostly acute hematogenous infections that require prompt management for satisfactory outcome. Despite high antibiotic susceptibility, treatment failure is frequent because of the severity of the infection and patients' advanced age, underlying diseases, and relapses.
authors.affiliation: Service d'Orthopédie et de Traumatologie Groupe Hospitalier Diaconesses-Croix Saint-Simon, F-75020 Paris, France. vzeller@hopital-dcss.org
authors.forename: Valérie
authors.initials: V
authors.lastname: Zeller
authors.forename: Marina
authors.initials: M
authors.lastname: Lavigne
authors.forename: Philippe
authors.initials: P
authors.lastname: Leclerc
authors.forename: Luc
authors.initials: L
authors.lastname: Lhotellier
authors.forename: Wilfrid
authors.initials: W
authors.lastname: Graff
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Ziza
authors.forename: Nicole
authors.initials: N
authors.lastname: Desplaces
authors.forename: Patrick
authors.initials: P
authors.lastname: Mamoudy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013292:Streptococcus agalactiae