DOI: 10.12890/2026_007348

Late-onset spinal implant infection due to Streptococcus salivarius probably triggered by a blood splash during a dental procedure

Authors

  • Yazeed Alekrish Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia 0000-0001-5051-7700
  • Maha Alrabiah Infectious Diseases Unit, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  • Ali Somily Department of Pathology (Microbiology Unit), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia
  • Faten Almohaideb Department of Radiology and Medical Imaging, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
  • Mazin Barry Infectious Diseases Unit, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Division of Infectious Diseases, Faculty of Medicine, University of Ottawa, Ottawa, Canada 0000-0003-2274-007X

yazeedalekrish@gmail.com

Keywords

Streptococcus salivarius, spinal implant infection, occupational exposure, blood splash, dentists

Abstract

Introduction: Spinal implant infections (SIIs) are a rare but well-known complication of spinal surgery. Early SIIs are usually caused by Staphylococcus aureus, beta-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.

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References

  1. Kowalski TJ, Berbari EF, Huddleston PM, Steckelberg JM, Mandrekar JN, Osmon DR. The Management and Outcome of Spinal Implant Infections: Contemporary Retrospective Cohort Study. Clin Infect Dis 2007;44:913–920. doi: 10.1086/512194
  2. Patel V, Mueller B, Mehbod AA, Pinto MR, Schwender JD, Garvey TA, Dawson JM, Perra JH. Removal of Spinal Instrumentation Is Not Required to Successfully Treat Postoperative Wound Infections in Most Cases. Cureus 2024;16:e56380. doi: 10.7759/cureus.56380
  3. Tai DBG, Patel R, Lovecchio F, Kwee T, Wouthuyzen-Bakker M. State-of-the-Art Review: Diagnosis and Management of Spinal Implant Infections. Clin Infect Dis 2024;79:e65–71. doi: 10.1093/cid/ciae436
  4. Tande AJ, Patel R. Prosthetic Joint Infection. Clin Microbiol Rev 2014;27:302–345. doi: 10.1128/cmr.00111-13
  5. Muschik M, Lück W, Schlenzka D. Implant removal for late-developing infection after instrumented posterior spinal fusion for scoliosis: reinstrumentation reduces loss of correction. A retrospective analysis of 45 cases. Eur Spine J 2004;13:645–651. doi: 10.1007/s00586-004-0694-4
  6. Margaryan D, Renz N, Bervar M, Zahn R, Onken J, Putzier M, et al. Spinal implant-associated infections: a prospective multicentre cohort study. Int J Antimicrob Agents 2020;56:106116. doi: 10.1016/j.ijantimicag.2020.106116
  7. Beltrami EM, Williams IT, Shapiro CN, Chamberland ME. Risk and Management of Blood-Borne Infections in Health Care Workers. Clin Microbiol Rev 2000;13:385–407. doi: 10.1128/CMR.13.3.385
  8. Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, et al. Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2013;56:e1–25. doi: 10.1093/cid/cis803
  9. Li HK, Rombach I, Zambellas R, Walker AS, McNally MA, Atkins BL, et al. Oral versus Intravenous Antibiotics for Bone and Joint Infection. N Engl J Med 2019;380:425–436. doi: 10.1056/NEJMoa1710926
  10. Abel N, Terrigno R, Kim N. Sharp, left-sided back pain · bilateral leg weakness · degenerative disc disease · Dx? J Fam Pract 2015;64:110–112.
  11. Ahmad S, Song D, Reyes JVM, Whiting A, Almas T, Lieber JJ. Hakuna mycotic aneurysm, Streptococcus salivarius does not always mean “no worries”. Ann Med Surg (Lond) 2021;69:102798. doi: 10.1016/j.amsu.2021.102798
  12. Murillo O, Roset A, Sobrino B, Lora-Tamayo J, Verdaguer R, Jiménez-Mejias E, et al. Streptococcal vertebral osteomyelitis: multiple faces of the same disease. Clin Microbiol Infect 2014;20:O33– O38. doi: 10.1111/1469-0691.12302

Published

2026-08-18

Issue

Vol. 13 No. 9 (2026)

Categories

How to Cite

1.
Alekrish Y, Alrabiah M, Somily A, Almohideb F, Barry M. Late-onset spinal implant infection due to Streptococcus salivarius probably triggered by a blood splash during a dental procedure. EJCRIM [Internet]. 2026 Aug. 18 [cited 2026 Nov. 3];13(9). Available from: https://ejcrim.com/index.php/ejcrim/article/view/7348