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Pathophysiology of surgical site infection in total hip arthroplasty
Abstract:
This article is a case report of a 69-year-old man who underwent a right total hip replacement procedure and developed a surgical site infection. Areas of concern in prevention and treatment of hip arthroplasty infection are presented, focusing on the pathophysiologic process involved. A review of the patient risk factors and the pathophysiologic action potentiating risk for infection include host immunity, nutritional status, diabetes, age, use of steroids or immunosuppressive drugs, rheumatoid arthritis, and urinary tract or other infections. The case report identifies the patient's age, multiple instrumentation of the bladder resulting in bacteriuria and the reinfusion of 400 cc of autologous shed blood via cell saver, a controversial risk subject, as the primary risk factors for surgical site infection in this patient. Readmission to the hospital on day 16 after the operation was completed on identification of 2 pathogenic organisms, methicillin-resistant Staphylococcus aureus and Acinetobacter calcoaceticus bio anitratus. The infection was successfully treated with oral ciprofloxacin and intravenous administration of tobramycin, preventing progression from superficial to deep infection and preserving the prosthesis.
Insights
A hip replacement patient developed a surgical site infection due to age, bladder instrumentation, and cell-saver blood reinfusion. Prompt antibiotic treatment with ciprofloxacin and tobramycin successfully preserved the prosthesis.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
Background:
- Surgical site infections (SSIs) are a significant complication following total hip arthroplasty (THA).
- Understanding patient-specific risk factors and pathophysiologic processes is crucial for SSI prevention and management.
Observation:
- A 69-year-old male patient developed an SSI post-THA.
- Identified risk factors included advanced age, bladder instrumentation leading to bacteriuria, and autologous shed blood reinfusion via cell saver.
- Postoperative infection with methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter calcoaceticus bio anitratus was confirmed on day 16.
Findings:
- The patient's specific risk factors contributed to the development of the surgical site infection.
- Successful treatment involved oral ciprofloxacin and intravenous tobramycin.
- The chosen antibiotic regimen prevented deep infection and preserved the hip prosthesis.
Implications:
- Highlights the importance of meticulous surgical site care and patient risk assessment in THA.
- Suggests careful consideration of cell saver usage in THA patients due to potential infection risks.
- Demonstrates effective antibiotic strategies for managing polymicrobial SSIs in hip arthroplasty.