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Anaerobic infection after total hip replacement. Report of three cases
Abstract:
In a series of 387 consecutive total hip replacements there were nine infections (2.3% infection rate). Three of the infections were caused by an anaerobic gram positive cocci, Peptococcus. This is an increased incidence of infection for this previously rare pathogen. The anaerobic infections occurred despite prophylactic antibiotic coverage with Keflin. No causative factors such as hospital, operating time, operating personnel, medical disease, or blood loss could be associated with the observed anaerobic infections. Two of the anaerobic infections appeared late. This is consistent with other reports of anaerobic infections in implants. Drainage after total hip arthroplasty operation must be cultured for anaerobes as well as aerobes, especially late infections in patients on prophylactic antibiotics. Drainage which is sterile to aerobic culture should alert the physician to a possible anaerobic infection.
Insights
Nine total hip replacements resulted in infection, with three caused by Peptococcus. This study highlights the risk of anaerobic infections, even with prophylactic antibiotics, emphasizing the need for anaerobic cultures in post-operative drainage.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Total hip replacement (THR) is a common orthopedic procedure.
- Surgical site infections (SSIs) are a significant complication following THR.
- Prophylactic antibiotics are standard to reduce SSI risk.
Observation:
- A series of 387 total hip replacements showed a 2.3% infection rate.
- Three infections (1% of total cases) were caused by Peptococcus, an anaerobic gram-positive cocci.
- This represents an increased incidence for this pathogen.
Findings:
- Anaerobic infections occurred despite prophylactic antibiotic coverage with Keflin.
- No specific causative factors (e.g., operating time, personnel, patient disease) were identified.
- Two anaerobic infections presented late, consistent with literature on anaerobic implant infections.
Implications:
- Drainage from THR should be cultured for both aerobic and anaerobic bacteria.
- Late infections in patients on prophylactic antibiotics warrant suspicion for anaerobic pathogens.
- Aerobic culture-negative drainage may indicate an anaerobic infection, requiring specific diagnostic consideration.