Late-Onset Spinal Implant Infection Due to Streptococcus Salivarius Probably Triggered by A Blood Splash During A Dental Procedure.

Abstract

Introduction: Spinal implant infections (SIIs) are a rare but well-known complication of spinal surgery. Early SIIs are usually caused by Staphylococcus aureus, β-haemolytic streptococci, or Gram-negative bacilli. On the other hand, late-onset SIIs are usually caused by coagulase-negative staphylococci or Cutibacterium acnes.

Case description: Here, we present a rare case of a late-onset SII in a 24-year-old dentist, caused by oral streptococcal flora (Streptococcus salivarius) that was probably inoculated into his conjunctival mucous membrane by a blood splash during a dental procedure, seven years after spinal fusion. He was initially treated broadly with empiric antibiotics as the organism was not identified, until it was later isolated from an intraoperative tissue culture. After that, he was given targeted antimicrobial therapy along with implant removal.

Discussion: The conjunctival mucosa is a well-established route of entry for blood-borne pathogens, particularly viral organisms, in health-care settings.

Conclusion: This treatment strategy resulted in significant improvement of his symptoms and general condition.

Learning points: In culture-negative or late-onset implant infection, a deliberate occupational and bloodborne-exposure history can reveal a source that cultures do not.Prior antimicrobial exposure markedly lowers culture yield and withholding antibiotics before intra-operative, or aspiration sampling can be decisive.Eye protection is essential for dental and other healthcare workers, as the conjunctiva is a viable portal for bacterial as well as viral transmission.