Acupuncture-related Digital Joint Infection Managed With Staged Surgery And Oral Antibiotic Therapy

Acupuncture is generally considered safe; however, inadequate aseptic technique may result in infections involving the skin, soft tissue, bone, or joints. Gram-negative bacilli causing hand infections are uncommon and may present diagnostic and therapeutic challenges, particularly when multiple digits are involved. A 73-year-old woman developed progressive pain, swelling, and functional limitation of the right third and left fifth fingers approximately 1 month after acupuncture. Imaging suggested osteomyelitis with involvement of the interphalangeal joint. Separate sterile specimens were obtained from each affected digit before antibiotic initiation. Cultures identified Morganella morganii in the right third finger and Proteus mirabilis in the left fifth finger. Both isolates were susceptible to third-generation cephalosporins, beta-lactam/beta-lactamase inhibitor combinations, carbapenems, and fluoroquinolones, with low minimum inhibitory concentrations supporting levofloxacin use. A staged surgical approach was performed, consisting of initial debridement with placement of antibiotic-loaded bone cement, followed by delayed wound repair after infection control. Systemic antimicrobial therapy was guided by susceptibility testing, transitioning from intravenous ceftriaxone to oral therapy. At discharge, oral levofloxacin (750 mg once daily) was prescribed to complete an approximately 6-week treatment course. At 6-week follow-up, both wounds had completely epithelialized, with resolution of swelling and marked pain reduction. Functional recovery was evident, with substantial improvement in interphalangeal joint range of motion. Inflammatory markers normalized, and follow-up radiographs demonstrated bone consolidation without recurrent infection. At 3 months, no relapse or systemic complications were observed. This case illustrates that, in selected patients with acupuncture-related digital osteoarticular infection, a stepwise approach integrating surgical debridement, microbiological confirmation, and susceptibility-guided antimicrobial therapy may achieve satisfactory short-term outcomes. High-bioavailability oral agents such as levofloxacin may be considered after initial infection control in carefully selected cases; however, this observation is based on a single case and requires validation in larger studies.