Periprosthetic joint infection associated with Mycoplasma hominis after transurethral instrumentation in an immunocompetent patient. Unusual or underestimated? A case report and review of the literature

Abstract

A B S T R A C TJudging by the small number of published cases, periprosthetic joint infections (PJI) caused by Mycoplasma species are regarded as unusual. This is not surprising as special growth conditions are necessary for diagnosis and therefore the laboratory must be informed of any clinical suspicion. However, surgeons are generally not aware of the risk factors associated with certain microorganisms causing an infection. Our laboratory therefore decided to adopt a new strategy: first, to address specific questions concerning the medical history of the patient and second, to make diagnosis of rare and fastidious microorganisms part of routine investigation, even if detailed information is not available.

The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections

“…The search for fastidious germs, such as moulds or mycobacteria, may be discussed, as it requires specific media [28]. Intracellular bacteria, like Mycoplasma, are rare causes of PJI, but should be considered and searched with a specific PCR [29]. This strategy may save time, as specific research can be considered earlier.…”

Occurrence of Rare Pathogens at the Site of Periprosthetic Hip and Knee Joint Infections: A Retrospective, Single-Center Study

“…To the best of our knowledge, the term "rare" has not yet been unambiguously defined in the literature with regard to orthopedic infections. Several terms, such as "rare", "atypical", and "unusual", have been used for the description of organisms that are not frequently identified at the sites of PJIs [12,18,20,21]. Caution must be exercised when trying to propose such a definition because rigorous scientific and clinical criteria are lacking, and such criteria might vary among different medical disciplines.…”

Shotgun-Metagenomics on Positive Blood Culture Bottles Inoculated With Prosthetic Joint Tissue: A Proof of Concept Study

“…Bacteria with weak or absent cell walls will be removed by the use of Molysis prior to DNA extraction. Among them, Mycoplasma, Ureaplasma, or Chlamydia, although unusual, are among the many organisms capable of causing PJIs (Geipel, 2009;Rieber et al, 2019). In addition, bacteria previously exposed to cell wall-targeting antibiotics will also be lysed and removed by the Molysis (Horz et al, 2010).…”