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Table 1 Summary of the reported cases of Mycoplasma hominis after joint or hip replacement

From: Infection due to Mycoplasma hominis after left hip replacement: case report and literature review

  1 [16] 2 [17] 3 [17] 4 [18] 5 [19] 6 current case
Case Number 1 1 1 1 1 1
Age (years) 62 71 76 66 54 59
Surgery Left total knee replacement due to knee osteoarthritis. Left total knee replacement. Left knee joint replacement. Bilateral total knee replacements 5 years ago and a left total hip replacement 2 years ago. Implantation of a total hip prosthesis one month before. Left hip replacement.
Gender Male Male Male Female Male Male
Fever Yes 39.7 °C 38.7 °C Yes Yes 38.5 °C
Infection indicators
 CRP(mg/L) 208.3 122.4 143.6 NA 374 200
 WBC(× 109/L) NA 10.25 (Neutrophils 81.4%) 11.83 (Neutrophils 88.3%) 6.0 6.9 15.4
 ESR(mm/hr) NA 61 63 101 NA 112
Microbiological test results Bacterial and fungi culture of wound exudation and seepage demonstrated a negative growth, whereas the secretion collected in the operation suggested a positive M. hominis growth, identified by mass spectrometer. Pinpoint, translucent colonies on Brucella agar after 2-day incubation of joint fluid, confirmed as M. hominis by 16S rRNA sequencing. Anaerobic culture for 3 days incubation of joint fluid indicated the growth of M. hominis. Cultures of the aspiration fluid of the knee revealed very small clear colonies were seen on the blood agar plates, present on both the aerobic and anaerobic plates. At the time of admission, Gram stain of a swab taken from the wound of the right hip showed rare leukocytes but no bacteria, and cultures were negative. Cultures of the effusion collected via arthroscopy of the left knee remained negative. The biopsy of the inflamed tissue revealed no bacteria on Gram staining, and no growth after 14-day culture. M. hominis. Was identified via16S rRNA sequencing. After 48 h of incubation on blood agar at 37 °C in a 5% CO2 atmosphere, tiny, non-hemolytic, transparent colonies were found on Columbia blood agar plates.
Presentation of post-surgical infection Blood seeping and pale clear liquid exudation from the wound were observed on the 3rd and 4th day after the surgery. Three days after operation, there were redness and swelling, pain at surgical site. One day after operation, fever, redness and swelling around knee were observed. NA Implantation of a total hip prosthesis one month before. Symptoms of a septic arthritis in both knees and hips and delayed wound healing and fistula formation after implantation of a total hip prosthesis one month before. Eight day after surgery, the patients presented with left hip pain and clinical signs of infection, including fever (38.5 °C), redness and swelling around the surgical site. And he reported significant local press pain. Approximately 400-ml light yellow, odorless effusion of the wound was drained.
Antibiotic prevention Cefazolin Ceftazidime, vancomycin Vancomycin NA NA Cefazolin
Antibiotic treatment. Cefazolin was replaced by vancomycin. Later transferred to the combination into erythromycin, clindamycin and minocyline. Vancomycin, metronidazole. Vancomycin. Later switched to azithromycin, doxycycline, moxifloxacin. Cefazolin 500 mg of tetracycline iv every 8 h. After the first week, switched to oral doxycycline (200 mg/day), and over the next 3 weeks. Ciprofloxacin and clindamycin; subsequently changed to cefazolin and clindamycin, continued for 4 weeks; and later changed to moxifloxacin and rifampin for a presumed chronic S. epidermidis infection. Treatment with moxifloxacin was initiated, however the patient’s condition continued to deteriorate. Cefepime, clindamycin, moxifloxacin, and doxycycline.
Blood culture Negative Negative Negative Negative Negative Negative
Outcome Recovery Recovery Recovery Recovery Dead Recovery
  1. WBC white blood cell, CSF cerebrospinal fluid, N negative, NA not available, w week, y year