Prosthetic joint infection(PJI) due to β-hemolytic streptococci (β-HS)

E. F. Berbari, M. C. Duffy, C. N. Morris, J. M. Steckelberg, A. D. Hanssen, D. R. Osmon

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Objective: To determine the epidemiology and outcome of PJI episodes due to β-HS Methods: All patients with a total hip (THA) or total knee (TKA) arthroplasty infection due to β-HS according to a strict case definition, seen at our institution between 1969 and 1991 were identified and their medical records reviewed. Treatment failure was defined as reoccurrence of GBS PJI according to the original case definition. Results: Thirty one THA and 9 TKA infections due to β-HS in 34 patients were identified. There were 20 males and 20 females with a median age of 69 years (range 44-95). The median time between joint arthroplasty and PJI was 2.4 years (range 0.1-13.1). Of the 40 episodes of β-HS PJI, 22 (55 %) were due to group B Streptococci, 12 (30 %) to group G streptococci, 4 (10%) to group A streptococci and 2 (5%) to group C streptococci. A malignancy was present in 13 (32.5%) of the cases, diabetes mellitus in 6 (15%), and rheumatoid arthritis in 6 (15%). 1/9 (11%) of β-HS PJI treated with two-stage exchange arthroplasty, 0/17 (0%) treated with resection arthroplasy or arthrodesis, 2/11 (18.2%) treated with debridement and retention of the prosthesis and 1/3 (33.4%) treated with antimicrobial therapy alone developed treatment failure after a median follow-up of 4.0 years (range 0.12-12.62). Effective parenteral antimicrobial therapy was administered in 39/40 episodes (penicillin (55%), cefazolin (27.5%), other (17.5%) for a median of 29 days (range: 3-57). Chronic oral antimicrobial suppression was used in 7/11 cases treated with debridment and retention of the components and in 1/3 cases treated with antimicrobial therapy alone. Conclusion: PJI due to β-HS is rare. A variety of different surgical and medical management strategies, including debridment and retention of the prosthesis followed by chronic oral antimicrobial suppression may be useful in treating β-HS PJI.

Original languageEnglish (US)
Number of pages1
JournalClinical Infectious Diseases
Issue number2
StatePublished - Dec 1 1997

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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