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Authors: Camelia E. Marculescu, M.D., Elie F. Berbari, M.D., Franklin R. Cockerill III, M.D.,
Douglas R. Osmon, M.D., M.P.H.


Addresses: 200 First Street SW Rochester, MN 55905

Purpose: To summarize the available medical literature regarding prosthetic joint infection due to unusual microorganisms including clinical presentation, methods of microbiologic diagnosis, and medical and surgical treatment strategies.

Methods: Review of medical literature of all reported cases of PJI caused by unusual or fastidious microorganisms.

Results: PJI due to Staphylococcus epidermidis, Staphylococcus aureus and β-hemolytic streptococci has been recognized for many years. These microorganisms are usually easily isolated on culture using conventional media. Other microorganisms that can cause PJI may be more difficult to culture or are not typically associated with PJI. In addition, recent advances in molecular microbiology and culture procedures have led to the discovery of microorganisms that are less commonly associated with PJI. PJI due to the following organsims are included in this paper Achromobacter xylosoxidans, Actinomyces spp., Aspergillus fumigatus, Bacillus alvei, Brucella spp., Candida spp., Campylobacter spp., Clostridium difficile, Corynebacterium JK, Dietzia maris, Echinococcus multilocularis, Francisella tularensis, Gemella spp., Haemophilus spp., Histoplasma capsulatum, Listeria monocytogenes, Mycobacterium avium complex, Mycobacterium chelonae, Mycobacterium fortuitum, Mycobacterium, tuberculosis, Mycoplasm hominis, Neisseria meningitidis, Nocardia spp, Oerskovia xantineolytica, Pasteurella multocida, Pseudomonas oryzyhabitans, Rhodotorula minuta, Salmonella spp., Sporothrix schenkii, Staphylocococcus caprae, Staphylococcus lugdunensis, Staphylococcus simulans, Streptococcus bovis, Streptococcus group C, Streptococcus pneumoniae, Tropheryma whipplei, Tsukamurella paurometabolum, and Yersinia enterocolitica.

Significance: This paper provides for the clinician and microbiologist an up to date, comprehensive review of the medical literature regarding the diagnosis and management of PJI due to unusual or fastidious microorganisms. Such a review is not currently available and will be an important resource for clinicians seeing PJI due to these microorganisms.

Musculoskeletal Infecton Society
Musculoskeletal Infecton Society
PO Box 714
Rochester, MN 55903