Clinical Characteristics and Outcomes of Staphylococcus lugdunensis Prosthetic Joint Infections: A Multicenter Retrospective Analysis

• Published in: Orthopedics (Thorofare, N.J.) Vol. 43; no. 6; pp. 345 - 350
• Main Authors: Masood, Komal, Redfern, Roberta E., Duggan, Joan M., Georgiadis, Gregory M., Suleyman, Geehan
• Format: Journal Article
• Language: English
• Published: United States Slack, Inc 01.11.2020; SLACK INCORPORATED
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Biofilms; Complications and side effects; Debridement; Demographics; Dosage and administration; Endocarditis; Female; Fractures; Hip Joint - microbiology; Hip Joint - surgery; Humans; Immune system; Infections; Intervention; Intravenous therapy; Knee Joint - microbiology; Knee Joint - surgery; Laboratories; Male; Middle Aged; Orthopedic implants; Patients; Penicillin; Polyethylene; Prevention; Prostheses; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - surgery; Retrospective Studies; Risk factors; Staphylococcal infections; Staphylococcal Infections - drug therapy; Staphylococcal Infections - surgery; Staphylococcus lugdunensis - isolation & purification; Surgery; United States
• ISSN: 0147-7447; 1938-2367; 1938-2367
• DOI: 10.3928/01477447-20200923-03

Staphylococcus lugdunensis has been increasingly recognized as a cause of serious infections, particularly prosthetic joint infections (PJIs). The aim of this study was to describe the clinical characteristics, treatments, and outcomes of S lugdunensis PJIs. This was a retrospective multicenter study of consecutive adult patients with S lugdunensis PJIs from January 2007 through December 2017; 28 patients met inclusion criteria. The knee was the most commonly affected joint (67.9%), followed by the hip (25%). Clinical and microbiologic characteristics, treatment modalities, and outcomes were evaluated. Thirteen (46.4%) patients had two-stage revision, 9 (32.1%) had debridement with or without revision, 5 (21.4%) had no surgical intervention, and 1 (3.6%) had one-stage revision. Twenty-four (85.7%) patients had monomicrobial infection with S lugdunensis , whereas 4 had polymicrobial. Two patients had concomitant bacteremia. All isolates, except 1, were susceptible to oxacillin. Three patients with no surgical intervention received oral antibiotics, 2 were not treated, and 1 was discharged to hospice. Relapse was observed in 2 of 13 (15%) patients who had two-stage revision, 4 of 9 (44%) who had debridement, and 6 of 6 (100%) who had no surgical intervention or one-stage revision regardless of antibiotic treatment regimen. There was a significant difference in cure rate for patients who underwent two-stage revision compared with other treatment modalities (85% vs 33%, P =.009). Appropriate management of S lugdunensis PJI includes both aggressive surgical treatment and a prolonged course of antibiotics and is associated with excellent clinical response. Regardless of route or duration of antibiotic therapy, relapse is high for patients not treated with two-stage revision. [ Orthopedics . 2020;43(6):345–350.]