Salvage of a Prosthetic Knee Joint Infected with Resistant Pneumococcus

Septic arthritis in a native joint is most commonly caused by Staphylococcus aureus, whereas coagulase-negative staphylococcal, streptococcal, and gram-negative organisms are common infections involving joints with prostheses1-3. Streptococcus pneumoniae is an uncommon cause of infection in a total knee joint, and pneumococcal infections resistant to multiple antibiotics are encountered even more rarely. In one study of 3210 total hip replacements, none of the forty-two documented infections were secondary to Streptococcus pneumoniae4. Poss et al. reviewed the records on 4240 hip, knee, and elbow replacements performed over a ten-year period and found that only one of fifty-three infections was due to Streptococcus pneumoniae5. In reviewing the literature, we were able to find only four case reports involving penicillin-resistant pneumococcal septic arthritis in adults and only one case involving both penicillin and ceftriaxone-resistant Streptococcus pneumoniae in septic arthritis.