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Staphylococcus lugdunensis: An Emerging Pathogen of Surgical Site Infections After Knee Arthroscopy–Related Procedures

Kadar, Assaf MD*; Bilavsky, Efraim MD; Tarabeia, Jalal PhD; Dekel, Michal MD; Rath, Ehud MD*

Infectious Diseases in Clinical Practice: May 2014 - Volume 22 - Issue 3 - p 161–164
doi: 10.1097/IPC.0b013e3182a4b48f
Original Articles

Purpose We report our experience with 4 patients with septic arthritis after knee arthroscopic related procedures with Staphylococcus lugdunensis as the pathogen.

Methods Between December, 2011 and September 2012, we identified 4 cases of knee arthroscopy–related procedures that were infected by S. lugdunensis postoperatively. The demographic, clinical, and laboratory data of these cases are described, as is the epidemiological investigation that followed this cluster of uncommon events.

Results Three patients who underwent anterior cruciate reconstructions procedures and 1 patient who underwent an artificial meniscus implant procedure presented with fever or a painful red knee within 1 week of the index surgery. Their C-reactive protein and white blood cell levels were elevated. All 4 grew S. lugdunensis from the synovial fluid aspirate with different antibiograms and were treated with urgent debridement and lavage followed by a prolonged course of intravenous antibiotics. Two patients needed more than 1 debridement of the joint. All patients reacted favorably to this course of treatment. A comprehensive infection control unit investigation did not uncover the source of this outbreak and suggested that the probable cause was disinfected arthroscopic equipment.

Conclusions S. lugdunensis has the propensity to cause an aggressive infection after arthroscopic procedures. Treatment with arthroscopic debridement and prolonged intravenous antibiotics resolved the infections in all of our 4 cases. Stringent observation of arthroscopic equipment sterilization protocols is warranted to prevent the recurrences of these infections.

From the *Division of Orthopedics; †Division of Epidemiology and Preventive Medicine; and ‡Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Correspondence to: Assaf Kadar, MD, Department of Orthopedics, Tel Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv 64239, Israel. E-mail:

The authors have no funding or conflicts of interest to disclose.

© 2014 by Lippincott Williams & Wilkins.