Septic arthritis with Staphylococcus lugdunensis following arthroscopic ACL revision with BPTB allograft

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 16; no. 1; pp. 15 - 18
• Main Authors: Mei-Dan, Omer, Mann, Gideon, Steinbacher, Gilbert, Ballester, Soleda J., Cugat, Ramon Bertomeu, Alvarez, Pedro Diaz
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 2008; Springer Nature B.V
• Subjects: Adult; Anterior Cruciate Ligament - surgery; Anterior Cruciate Ligament Injuries; Anti-Infective Agents - therapeutic use; Arthritis, Infectious - drug therapy; Arthritis, Infectious - etiology; Arthroscopy - adverse effects; Bone-Patellar Tendon-Bone Grafting - adverse effects; Ciprofloxacin - therapeutic use; Hospital costs; Humans; Knee; Knee Joint - microbiology; Knee Joint - surgery; Male; Medicine; Medicine & Public Health; Orthopedics; Reoperation; Rifampin - therapeutic use; Sports medicine; Staphylococcal Infections - diagnosis; Staphylococcal Infections - drug therapy; Staphylococcus - isolation & purification; Surgical Wound Infection - drug therapy; Surgical Wound Infection - microbiology; Transplantation, Autologous; Allograft; ACL; Septic arthritis
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-007-0379-8

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.