Background Granulicatella and Abiotrophia spp. are difficult to detect due to
their complex nutritional requirements. Infections with these organisms are
associated with high treatment failure rates. We report the first implant-
associated infection caused by Granulicatella para-adiacens, which was cured
with anti-microbial treatment consisting of anti-biofilm-active rifampin and
debridement, exchange of mobile parts and retention of the prosthesis. Case
presentation Patient with a history of left hip arthroplasty presented with
acute onset of fever, pain and limited range of motion of the left hip.
Arthrocentesis of the affected joint yielded purulent fluid and exchange of
mobile parts of the prosthesis, but retention of fixed components was
performed. Granulicatella para-adiacens grew from preoperative and
intraoperative cultures, including sonication fluid of the removed implant.
The transesophageal echocardiography showed a vegetation on the mitral valve;
the orthopantogram demonstrated a periapical dental abscess. The patient was
treated with intravenous penicillin G and gentamicin for 4 weeks, followed by
levofloxacin and rifampin for additional 2 months. At discharge and at follow-
up 1, 2 and 5 years later, the patient was noted to have a functional, pain-
free, and radiologically stable hip prosthesis and the serum C-reactive
protein was normal. Conclusions Although considered a difficult-to-treat
organism, we report a successful treatment of the Granulicatella hip
prosthesis infection with prosthesis retention and a prolonged antibiofilm
therapy including rifampin. The periapical dental abscess is considered the
primary focus of hematogenously infected hip prosthesis, underlining the
importance treatment of periodontitis prior to arthroplasty and of proper oral
hygiene for prevention of hematogenous infection after arthroplasty
