Group B Streptococcal Prosthetic Joint Infections

Joan M. Duggan, MD, Gregory Georgiadis, MD, Cornel VanGorp, MD, James Kleshinski, MD


J South Orthop Assoc. 2001;10(4) 

In This Article

Abstract and Introduction

We report 6 cases of group B streptococcal prosthetic joint infections seen in our institution and review 8 previously reported cases. These 14 patients (6 men and 8 women) had an average age of 69. Seven hip joints and 7 knee joints were affected. Only 4 patients had risk factors for prosthetic joint infection (diabetes mellitus in 2, cancer in 1, and myelodysplasia in 1). The average time from surgery to onset of symptoms was approximately 4 years (range, 5 months to 10 years). Pain in the affected joint was the chief complaint. Six patients had bacteremia. Seven patients had known or suspected foci of infection, which were genitourinary tract (1), skin and soft tissue trauma sites (1), gastrointestinal tract (1), and oropharynx (1). Nine patients required prosthesis removal in addition to antibiotic therapy. Two patients had apparent cure of the infection with retention of the prosthesis. Group B streptococcal prosthetic joint infections appear to be a late complication of prosthetic joint replacement surgery.

Streptococcus agalactiae (group B streptococci) commonly colonize the genital and lower gastrointestinal tract and less commonly may be found in the oropharynx. While infections with group B streptococci (GBS) in pregnant women and neonates are well documented, invasive GBS infections have been increasingly recognized in nonpregnant adult patients as well. Invasive disease is associated with a mortality that ranges from 21% to 32% in nonpregnant adults.[1] Clinical manifestations of GBS infections in the neonate include sepsis, meningitis, bacteremia, osteomyelitis, and septic arthritis. In pregnant women, urinary tract infections, amnionitis, endometritis, and skin and soft tissue infections are the most common types of localized infection. Invasive disease during pregnancy, however, consists primarily of bacteremia, sepsis, and meningitis.[1]

In nonpregnant adults, clinical manifestations of infection include skin and soft tissue infections, osteomyelitis, bacteremia, urosepsis, pneumonia, and endocarditis.[2] In one study of 219 men and nonpregnant women with group B streptococcal infection, risk factors for the development of disease included cirrhosis, diabetes, stroke, breast cancer, decubitus ulcers, and neurogenic bladder.[3] Group B streptococci remain susceptible to penicillin in vitro, making this agent the main treatment of choice. Approximately 4% to 6% of strains is tolerant to penicillin in vitro, but the clinical significance of this finding is unknown.

Despite the increasing frequency of GBS skin and soft tissue infections and osteomyelitis in nonpregnant adults, group B streptococcal infections of prosthetic joints have rarely been reported.[4,5,6,7,8,9] We present six cases of community acquired GBS prosthetic joint infections and review eight previously reported cases of prosthetic joint infections with this organism.