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Total hip prosthesis complication, periprosthetic infection with external fistulizing due to Enterobacter cloacae
Introduction:
The Enterobacter cloacae is a microorganism found in the intestinal flora of the majority of animals, including humans. Primary infections caused by E. cloacae are rare in immunocompetent patients, but are very common in hospital settings in newborns and immunocompromised patients, and can be aggravated by the insurgence of antibiotic resistance. The incidence of periprosthetic hip infections is just below 2%.
Case Presentation:
A 76year old woman with multiple comorbidities underwent surgical implantation of intermediary total hip prosthesis of the left hip, in a different health facility, in February 2014, after the basicervical fracture of the upper femur extremity due to trauma. After an episode of dislocation of the prosthetic implant, in September 2014, she underwent a surgical operation to implant the acetabular component. A month later not in our facility, following a re-hospitalization for the dislocation of the arthroprosthesis, an infection from E. cloacae complex was discovered. After 2 years of chronic infection she came to our attention; the clinical picture featured coxalgia and secreting fistula in the surgical wound. Following a specific antibiotic therapy, carried out intravenously over the course of a month, we decided to intervene removing the left hip arthroprosthesis and placing an antibiotic spacer following the direction deduced from the antibiogram study of August 2016.
Conclusion:
The patient was hospitalized in our facility and 2 months later she underwent another operation to remove the antibiotic spacer and to place a new total hip arthroprosthesis. Multiple swabs showed the complete healing from the infection, which was confirmed a couple of months later.
Insights
Enterobacter cloacae infections can complicate hip replacements, especially in immunocompromised individuals. This case highlights successful treatment of a chronic periprosthetic hip infection with debridement, antibiotic spacer, and eventual reimplantation.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Microbiology
Background:
- Enterobacter cloacae is a common gut bacterium that can cause opportunistic infections, particularly in hospital settings.
- Antibiotic resistance in E. cloacae poses a significant challenge in treating infections, especially in vulnerable patient populations.
- Periprosthetic hip infections occur in approximately 2% of patients undergoing hip arthroplasty.
Purpose of the Study:
- To present a case study of a chronic periprosthetic hip infection caused by Enterobacter cloacae complex.
- To illustrate the management and successful treatment of a complex hip implant infection.
Main Methods:
- A 76-year-old female patient with multiple comorbidities presented with a chronic left hip periprosthetic infection.
- Initial treatment involved intravenous antibiotics followed by surgical removal of the arthroplasty and placement of an antibiotic spacer.
- A subsequent surgery was performed to remove the spacer and implant a new total hip arthroplasty.
Main Results:
- The patient had a history of multiple hip surgeries and dislocations leading to the chronic infection.
- Following a month of antibiotic therapy and the use of an antibiotic spacer, the infection was eradicated.
- Post-reimplantation, serial swabs confirmed complete healing and resolution of the infection.
Conclusions:
- Successful management of chronic Enterobacter cloacae periprosthetic hip infections is achievable through a multi-stage surgical approach.
- The use of an antibiotic spacer is a crucial component in eradicating persistent infections before definitive arthroplasty.
- This case underscores the importance of tailored antibiotic therapy guided by antibiogram results in complex orthopedic infections.
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