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Rapid bone destruction caused by multidrug-resistant Pseudomonas aeruginosa septic arthritis: A case report
Sung Cheol Yang1, Yong In1, Saad Mohammed AlShammari2
1Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Rationale:
Infections due to multidrug-resistant (MDR) Pseudomonas aeruginosa are strongly associated with poor outcomes, including prolonged hospitalization and an increased risk of mortality. Antimicrobial options for the treatment of severe infections due to MDR P aeruginosa are quite limited, and treatment remains challenging.
Patient Concerns:
A 65-year-old woman presented to our orthopedic clinic with a 3-month history of progressive pain and stiffness in her left knee. Her primary care provider administered a hyaluronic acid injection, which unfortunately resulted in worsening symptoms. Subsequent treatment included a 1-month course of intravenous gentamicin and ceftriaxone, which failed to alleviate her symptoms.
Diagnosis:
MDR P aeruginosa septic arthritis of the knee. The culture isolate was tested for susceptibility to multiple antibiotics. Magnetic resonance imaging evaluations were conducted, showing notable erosive and osteolytic changes around the joint surfaces that had progressed significantly.
Interventions:
The patient underwent arthroscopic irrigation and synovectomy. The treatment regimen included a combination of intravenous colistin and piperacillin/tazobactam administered over a 6-week period. Total knee arthroplasty was performed 6 months later without additional antibiotic treatment.
Outcomes:
Patient's knee condition remained continuously stable without abnormal findings of inflammation. The patient's knee range of motion increased 0 to 125 degrees, her pain almost disappeared, and she was able to maintain activities of daily life.
Lessons:
This case underscores the challenges of managing infections with MDR organisms in complex clinical scenarios, emphasizing the need for timely intervention and appropriate antibiotic therapy.
Insights
This case study highlights successful treatment of multidrug-resistant Pseudomonas aeruginosa knee septic arthritis using colistin and piperacillin/tazobactam. The intervention led to symptom resolution and improved knee function, demonstrating effective management of challenging infections.
Area of Science:
- Orthopedics
- Infectious Diseases
- Microbiology
Background:
- Multidrug-resistant (MDR) Pseudomonas aeruginosa infections are linked to poor patient outcomes and mortality.
- Limited antimicrobial options exist for severe MDR P. aeruginosa infections, posing treatment challenges.
Purpose of the Study:
- To report a case of successful management of MDR P. aeruginosa septic arthritis of the knee.
- To highlight the effectiveness of a specific antibiotic regimen in a complex clinical scenario.
Main Methods:
- A patient with a 3-month history of knee pain and prior failed treatments presented with MDR P. aeruginosa septic arthritis.
- Diagnosis was confirmed by culture and MRI showing significant erosive changes.
- Treatment involved arthroscopic irrigation, synovectomy, and a 6-week course of intravenous colistin and piperacillin/tazobactam, followed by total knee arthroplasty.
Main Results:
- The patient achieved a stable knee condition with no inflammation.
- Significant improvement in knee range of motion (0 to 125 degrees) and near-complete pain resolution.
- Restoration of daily living activities post-treatment.
Conclusions:
- This case demonstrates the successful management of a challenging MDR P. aeruginosa knee infection.
- Timely intervention and appropriate combination antibiotic therapy are crucial for favorable outcomes.
- Highlights the need for effective treatment strategies against resistant bacterial infections.
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