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Prosthetic joint and implant contamination caused by Ralstonia pickettii : a report of three cases ٭

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ABSTRACT

We describe three cases of orthopaedic contamination caused by Ralstonia pickettii grown from prosthetic joint and implant material cultures following sonication in the microbiology laboratory. Given the temporal association between the cases, lack of clinical or intra-operative features of infection, growth of the organism in the water bath, and unlikely etiology of Ralstonia as a prosthetic joint or implant pathogen, the bacteria were judged to be contaminants.

No MeSH data available.


True AP view of the left shoulder approximately 15 months from undergoing revision ORIF and bone grafting of a surgical neck nonunion of the proximal humerus. There is evidence of early hardware failure (screw pullout), graft resorption, and persistent nonunion of the surgical neck.
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Figure 3: True AP view of the left shoulder approximately 15 months from undergoing revision ORIF and bone grafting of a surgical neck nonunion of the proximal humerus. There is evidence of early hardware failure (screw pullout), graft resorption, and persistent nonunion of the surgical neck.

Mentions: Multiple deep-tissue cultures and the humeral plate were sent for microbiological and pathological assessment. Histopathology revealed chronic inflammation with rare neutrophils and no bacteria. Bacterial culture of the plate grew R. pickettii after three days’ incubation. However, the laboratory notified the treating physicians that contamination was likely based on the previously reported cases. Culture of the water bath again grew R. pickettii. All other culture results were negative including those specifically held for P. acnes (i.e., after 14 days). At 15 months of follow-up, the patient complained of worsening shoulder pain but no infectious symptoms. Radiographically, she was found to have a persistent atrophic nonunion of the surgical neck with early hardware loosening (Figure 3). Preliminary infection work-up was normal (i.e., bloodwork and WBC scan) while metabolic work-up revealed Vitamin D deficiency. Plans were made for revision surgery.


Prosthetic joint and implant contamination caused by Ralstonia pickettii : a report of three cases ٭
True AP view of the left shoulder approximately 15 months from undergoing revision ORIF and bone grafting of a surgical neck nonunion of the proximal humerus. There is evidence of early hardware failure (screw pullout), graft resorption, and persistent nonunion of the surgical neck.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5385672&req=5

Figure 3: True AP view of the left shoulder approximately 15 months from undergoing revision ORIF and bone grafting of a surgical neck nonunion of the proximal humerus. There is evidence of early hardware failure (screw pullout), graft resorption, and persistent nonunion of the surgical neck.
Mentions: Multiple deep-tissue cultures and the humeral plate were sent for microbiological and pathological assessment. Histopathology revealed chronic inflammation with rare neutrophils and no bacteria. Bacterial culture of the plate grew R. pickettii after three days’ incubation. However, the laboratory notified the treating physicians that contamination was likely based on the previously reported cases. Culture of the water bath again grew R. pickettii. All other culture results were negative including those specifically held for P. acnes (i.e., after 14 days). At 15 months of follow-up, the patient complained of worsening shoulder pain but no infectious symptoms. Radiographically, she was found to have a persistent atrophic nonunion of the surgical neck with early hardware loosening (Figure 3). Preliminary infection work-up was normal (i.e., bloodwork and WBC scan) while metabolic work-up revealed Vitamin D deficiency. Plans were made for revision surgery.

View Article: PubMed Central - PubMed

ABSTRACT

We describe three cases of orthopaedic contamination caused by Ralstonia pickettii grown from prosthetic joint and implant material cultures following sonication in the microbiology laboratory. Given the temporal association between the cases, lack of clinical or intra-operative features of infection, growth of the organism in the water bath, and unlikely etiology of Ralstonia as a prosthetic joint or implant pathogen, the bacteria were judged to be contaminants.

No MeSH data available.