title: Listeria monocytogenes-associated joint and bone infections: a study of 43 consecutive cases.
abstract: BACKGROUND
  Little is known about Listeria monocytogenes-associated bone and joint infections. Only case reports of this infection have been published.
  
  
  METHODS
  Retrospective study of culture-proven bone and joint cases reported to the French National Reference Center for Listeria from 1992 to 2010.
  
  
  RESULTS
  Forty-three patients were studied: 61% were men, and the median age was 72 (range, 16-89); 24 patients exhibited comorbidities (56%). Thirty-six patients (84%) had orthopedic implant devices: prosthetic joints (n = 34) or internal fixation (n = 2); the median time after insertion was 9 years (0.1-22). Subacute infection was more frequent (median, 4 weeks [range, 2-100], 74%) than acute infection (<7 days, 23%), with nonspecific clinical features; 45% of patients had no fever. Blood cultures were positive in 3 of 19 cases. Isolate polymerase chain reaction genogrouping revealed 4 patterns: IVb (21 of 42, 50%), IIa (17 of 42, 40%), IIb (2 of 42, 5%), and IIc (2 of 42, 5%). Five groups of strains with similar pulsotype patterns were identified without an epidemiological link. Antibiotics, primarily amoxicillin (80%) with aminoglycosides (48%), were prescribed for a median duration of 15 weeks (range, 2-88). Eighteen patients (50%) underwent prosthesis replacement; all were successful after median follow-up of 10 months (range, 1-75). Five of 13 patients for whom material was not removed had protracted infection despite prolonged antibiotherapy; 3 of these patients later underwent prosthesis replacement with sustained recovery.
  
  
  CONCLUSIONS
  Osteoarticular listeriosis primarily involves prosthetic joints and occurs in immunocompromised patients. It requires intensive treatment with antibiotherapy and usually requires implant removal or replacement for cure.
authors.affiliation: Institut Pasteur, French National Reference Center and WHO Collaborating Center for Listeria, Microbes and Host Barriers Group, Université Paris Descartes, Centre d’Infectiologie Necker-Pasteur, Hôpital Necker-Enfants Malades, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Charlier
authors.forename: Alexandre
authors.initials: A
authors.lastname: Leclercq
authors.forename: Benoît
authors.initials: B
authors.lastname: Cazenave
authors.forename: Nicole
authors.initials: N
authors.lastname: Desplaces
authors.forename: Laetitia
authors.initials: L
authors.lastname: Travier
authors.forename: Thomas
authors.initials: T
authors.lastname: Cantinelli
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.forename: Véronique
authors.initials: V
authors.lastname: Goulet
authors.forename: Alban
authors.initials: A
authors.lastname: Le Monnier
authors.forename: Marc
authors.initials: M
authors.lastname: Lecuit
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018441:Biofilms; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005602:France; D006801:Humans; D008089:Listeria monocytogenes / Q000145:classification / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D008088:Listeriosis / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy / Q000382:microbiology*; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000382:microbiology*; D012189:Retrospective Studies