Late hip arthroplasty infection caused by Listeria monocytogenes in a non-immunocompromised patient

Prosthetic joint infections caused by Listeria monocytogenes are uncommon. Such infections usually occur in patients with malignant disease, diabetes mellitus, chronic kidney disease, or liver disease or in elderly or immunocompromised patients.

We describe a non-immunocompromised 78-year-old male with hip infection caused by L. monocytogenes 11 years after arthroplasty. Eight years postoperatively, revision of the acetabular prosthesis was performed. Two months after that operation, the patient presented with fever, severe left hip pain, inability to bear weight, and painful restriction of left hip motion; the incision site was tender and erythematous. Joint fluid aspirate yielded L. monocytogenes and Staphylococcus epidermidis. Staged revision of the arthroplasty was performed. A gentamicin-loaded polymethylmethacrylate spacer was implanted, and the patient received ampicillin. At the second-stage operation, the cement spacer was removed, and a cement-less total hip arthroplasty was implanted. Postoperative recovery was uneventful, and two years later, the patient has had no joint problems.

Predisposing conditions and co-morbidities usually are required for L. monocytogenes infection. Listeria is fastidious and is not a recognized laboratory isolate or hospital contaminant; routine cultures therefore may be negative. In approximately one-half of the reported cases, the prosthetic joint infections were treated successfully by two-stage revision surgery plus long-term antibiotic therapy. In most cases, ampicillin and gentamicin are the first choice. Cephalosporins are rarely effective.