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Clin Infect Dis. 2012 Jan 15;54(2):240-8. doi: 10.1093/cid/cir803. Epub 2011 Nov 18.

Listeria monocytogenes-associated joint and bone infections: a study of 43 consecutive cases.

Author information

1
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.

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.

PMID:
22100574
DOI:
10.1093/cid/cir803
[Indexed for MEDLINE]

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