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Sebastian S, Dhawan B, Malhotra R, Gautam D, Kapil A. Salmonella typhimurium infection in total knee arthroplasty: A case report with review of literature. J Lab Physicians 2020; 9:217-219. [PMID: 28706395 PMCID: PMC5496303 DOI: 10.4103/0974-2727.208254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Salmonella enterica serotype Typhimurium is a rare cause of prosthetic joint infection (PJI). The recognized predisposing risk factors for Salmonella septic arthritis include diabetes mellitus, renal failure, human immunodeficiency virus infection and chronic corticosteroid use. We describe a case of PJI of the knee in a 74-year-old lady who was on antitubercular treatment. The patient presented with discharging sinus and raised inflammatory markers. She was successfully treated by the removal of prosthesis and debridement followed by ciprofloxacin therapy for 6 weeks. This case report highlights the potential virulence of Salmonella in immunocompromised patient with a joint prosthesis. Continuous monitoring and close collaboration of microbiologists and orthopedicians helped obtain the resolution of infection in our patient.
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Affiliation(s)
- Sujeesh Sebastian
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Benu Dhawan
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gautam
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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I-fan Lo, Hao-chiun Chang. Salmonella Septic Arthritis in A Patient with A Hip Implant: A Case Report. INT J GERONTOL 2018. [DOI: 10.1016/j.ijge.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Gupta A, Berbari EF, Osmon DR, Virk A. Prosthetic joint infection due to Salmonella species: a case series. BMC Infect Dis 2014; 14:633. [PMID: 25424009 PMCID: PMC4258011 DOI: 10.1186/s12879-014-0633-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 11/13/2014] [Indexed: 02/08/2023] Open
Abstract
Background Prosthetic joint infection (PJI) due to Salmonella is rare. Numerous outbreaks of Salmonella have been reported throughout the United States in the last decade. We reviewed and analyzed cases of Salmonella PJI seen at our institution. Methods The medical records of all patients diagnosed with a Salmonella PJI between 1969–2013 were reviewed. Patients were followed till death, treatment failure or loss to follow-up. Results Six patients of Salmonella PJI were identified during the 44 year study period. Five were male; median age was 63.5 years (range 52–76). Five patients were immunodeficient. Five had a total hip arthroplasty infection, while one had a total knee arthroplasty infection. Median prosthesis age at the time of diagnosis of first episode of Salmonella PJI was 5 years (range 4 months-9 years). Four presented with fever and constitutional signs within two weeks of symptom onset. Two patients each had gastrointestinal symptoms and Salmonella bacteremia. Salmonella enterica serovar Enteritidis was the most common organism isolated (4 patients). None were Salmonella enterica serovar Typhi. Initial management included aspiration and antimicrobial therapy only (3), debridement and component retention (1) and two-staged exchange (2). All four patients treated without resection failed treatment a median of 2.5 months (range 2–11) after diagnosis and required resection arthroplasty. All six patients who underwent prosthesis removal (and exchange or arthrodesis) had successful outcome with a median duration of follow-up of 11 years (range 4–21). Three of these received oral antimicrobial therapy for a median duration eight weeks (range 4–8) and three received parenteral antimicrobial therapy for a median duration of six weeks (range 4–6). Conclusions The increase in Salmonella outbreaks does not seem to lead to increased Salmonella PJI. PJIs due to Salmonella remain rare, and the presentation is often acute with fever. It frequently occurs in immunocompromised patients. In our patient population, removal of prosthesis with or without reimplantation, along with 4–6 weeks of effective parenteral antimicrobial therapy was most often associated with successful eradication of infection.
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Affiliation(s)
- Arjun Gupta
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA. .,Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
| | - Elie F Berbari
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Douglas R Osmon
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Abinash Virk
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
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Abstract
Orthopaedic implants are highly susceptible to infection. The aims of treatment of infection associated with internal fixation devices are fracture consolidation and prevention of chronic osteomyelitis. Complete biofilm eradication is not the primary goal, as remaining adherent microorganisms can be removed with the device after fracture consolidation. By contrast, in periprosthetic joint infection (PJI), biofilm elimination is required. Surgical treatment of PJI includes debridement with retention, one- or two-stage exchange and removal without reimplantation. In addition, prolonged antibiotic treatment, preferably with an agent that is effective against biofilm bacteria, is required. Rifampicin is an example of an antibiotic with these properties against staphylococci. However, to avoid the emergence of resistance, rifampicin must always be combined with another antimicrobial agent. With this novel treatment approach, orthopaedic implant-associated infection is likely to be eradicated in up to 80-90% of patients. Because most antibiotics have a limited effect against biofilm infections, novel prophylactic and therapeutic options are needed. Surface coating with antimicrobial peptides that reduce bacterial attachment and biofilm formation can potentially prevent implant-associated infection. In addition, quorum-sensing inhibitors are a novel therapeutic option against biofilm infections.
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Affiliation(s)
- W Zimmerli
- Interdisciplinary Unit of Orthopaedic Infections, Kantonsspital Baselland, University of Basel, Liestal, Switzerland
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Jeroense KTV, Kuiper JWP, Colen S, Schade RP, Saouti R. One-stage revision in two cases of Salmonella prosthetic hip infection. World J Clin Cases 2014; 2:304-308. [PMID: 25032209 PMCID: PMC4097161 DOI: 10.12998/wjcc.v2.i7.304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/17/2014] [Accepted: 05/29/2014] [Indexed: 02/05/2023] Open
Abstract
We describe two cases of prosthetic joint infection (PJI) of the hip due to Salmonella. The first patient presented with an early infection 5 d after being discharged following a total hip replacement and the second patient presented at the emergency ward with a late infection, thirteen years following a total hip replacement. Both cases occurred within one month of each other at our institution and both were successfully treated with a one-stage revision. PJI caused by Salmonella species is very rare: so far only 20 Salmonella PJIs of the hip have been described. Therefore, full consensus on the best treatment approach has not yet been reached. An aggressive two-stage approach is advised because of the virulence of Salmonella, although a limited number of successful one-stage approaches have been described as well. According to the latest guidelines, one-stage revision has comparable success rates and less morbidity compared to two-stage treatment, when selecting the right patients. In our opinion, PJI caused by Salmonella should be treated just as PJI caused by other bacteria, with consideration of the selection criteria as mentioned in several treatment guidelines. As illustrated by these two cases, one-stage revision can be successful in both early and late Salmonella PJI of the hip.
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de la Torre B, Tena D, Arias M, Romanillos O. Recurrent prosthetic joint infection due to Salmonella enteritidis: case report and literature review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 22 Suppl 1:89-97. [DOI: 10.1007/s00590-012-0955-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 01/20/2012] [Indexed: 12/17/2022]
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Salmonella septic arthritis following total knee arthroplasty for rheumatoid arthritis in a patient receiving etanercept. J Orthop Sci 2011; 16:258-62. [PMID: 21301900 DOI: 10.1007/s00776-011-0023-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 05/19/2010] [Indexed: 10/18/2022]
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Tóth K, Janositz G, Kovács G, Sisák K, Rudner E. Successful treatment of late Salmonella infections in total hip replacement - report of two cases. BMC Infect Dis 2010; 10:160. [PMID: 20529326 PMCID: PMC2894836 DOI: 10.1186/1471-2334-10-160] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 06/08/2010] [Indexed: 12/14/2022] Open
Abstract
Background Salmonella species can be rarely isolated from periprosthetic joint infections, however when present, are usually part of a severe septic clinical picture. Case presentations Two patients presented with late infected hip replacements to our institution. The first patient with multiple comorbidities had a confirmed Salmonella Enteridis infection with an abscess in the groin, with loosening of both components. He underwent a successful one stage cemented revision hip replacement, followed by 6 weeks of antibiotic therapy (ciprofloxacin). He had no recurrence or complications. The second patient was admitted in a septic condition with ARDS to the Intensive Care Unit 7 years following an uncemented total hip replacement. From an ultrasound guided hip aspirate Salmonella cholerae-suis was isolated. He underwent a successful a two-stage revision hip replacement. Conclusions Successful treatment of such potentially life threatening infections is achievable using modern orthopaedic techniques and close collaboration with the infectious diseases specialists.
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Affiliation(s)
- Kálmán Tóth
- Department of Orthopaedics, University of Szeged, 6 Semmelweis Street, Szeged 6720, Hungary.
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Kobayashi H, Hall GS, Tuohy MJ, Knothe U, Procop GW, Bauer TW. Bilateral periprosthetic joint infection caused by Salmonella enterica serotype Enteritidis, and identification of Salmonella sp using molecular techniques. Int J Infect Dis 2009; 13:e463-6. [PMID: 19269872 DOI: 10.1016/j.ijid.2008.12.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 11/17/2008] [Accepted: 12/15/2008] [Indexed: 12/18/2022] Open
Abstract
Salmonella septic arthritis is rare. Our objective was to identify bacterial species from joint fluid using a broad-range real-time PCR and pyrosequencing technique. We describe a case of bilateral Salmonella enterica serotype Enteritidis infection of right and left total knee arthroplasties. DNA was extracted from the joint fluid of the left knee, amplified by PCR, and the amplicons were evaluated by pyrosequencing. The patient was treated with ciprofloxacin, and the polyethylene liners were replaced in both knees. The results of pyrosequencing detected a Salmonella species. To the best of our knowledge, this is the first report describing the detection of Salmonella in joint fluid by universal PCR followed by pyrosequencing.
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Affiliation(s)
- Hideo Kobayashi
- Pathology and Laboratory Medicine Institute, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA
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Muñoz-Mahamud E, Casanova L, Font LL, Fernández-Valencia JA, Bori G. Septic arthritis of the hip caused by nontyphi Salmonella after urinary tract infection. Am J Emerg Med 2009; 27:373.e5-373.e8. [DOI: 10.1016/j.ajem.2008.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Accepted: 07/20/2008] [Indexed: 11/16/2022] Open
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Marculescu CE, Berbari EF, Cockerill FR, Osmon DR. Unusual aerobic and anaerobic bacteria associated with prosthetic joint infections. Clin Orthop Relat Res 2006; 451:55-63. [PMID: 16906072 DOI: 10.1097/01.blo.0000229317.43631.81] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The association of certain microorganisms, such as Staphylococcus epidermidis, Staphylococcus aureus, and beta-hemolytic streptococci, with prosthetic joint infection (PJI) has been recognized for many years. To our knowledge, a systematic review of the presentation and management of less commonly encountered species of coagulase-negative staphylococci, nutritional-variant streptococci, aerobic non-spore and spore forming Gram-positive or anaerobic bacteria is not available. We therefore sought to provide a comprehensive literature review of PJI due to these microorganisms that will provide a valuable and quick reference for clinicians caring for these patients. We conducted a Medline search of all case reports and case series of PJI due to unusual aerobic and anaerobic bacteria. The presentation, surgical, and medical management strategies were reviewed. Appropriate medical and surgical management of such infections is complex and evolving as newer diagnostic tests, surgical techniques and antimicrobials become available. Management of patients with these infections requires close collaboration between the orthopaedic surgeon, infectious disease specialist and microbiology laboratory.
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Affiliation(s)
- David B Musante
- Division of Orthopedics, Duke University Medical Center, Durham, NC 27710, USA
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Abstract
We describe a case of Salmonella enteritidis infection of a prosthetic knee joint that was cured with ceftriaxone therapy for 6 weeks and replacement of the tibial component of the prosthesis. Eleven other cases of salmonella prosthetic joint infection have been reported in the English-language literature. Five infections occurred within 20 days of prosthesis placement, and seven occurred several months to years later; ten of 12 infections involved hip prostheses. Nine of 12 patients who had prosthesis removal were cured of the infection. Two of the three patients with retention of the prosthesis required long-term suppressive antibiotic therapy.
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Affiliation(s)
- L J Day
- Division of Infectious Diseases, Department of Internal Medicine, Ann Arbor Veterans Affairs Health System, University of Michigan Medical School, 2215 Fuller Road, Ann Arbor, MI 48105, USA
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Tattevin P, Crémieux AC, Joly-Guillou ML, Carbon C. First case of Salmonella hirschfeldii (paratyphi C) infection of a prosthetic hip. Clin Microbiol Infect 1998; 4:228-230. [PMID: 11864333 DOI: 10.1111/j.1469-0691.1998.tb00676.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Abstract
OBJECTIVES The recent decades witnessed the increased incidence of bacteremia with nontyphi Salmonella, especially in patients with underlying diseases. To evaluate clinically the patients with bacteremia by nontyphi Salmonella, we investigated the clinical records of the patients. METHODS Retrospective study was performed on 30 cases of bacteremia with nontyphi Salmonella admitted to Soon Chun Hyang University Hospital from 1987 to 1993, and we analyzed with regard to age distribution, underlying diseases, clinical presentation and fatality. RESULTS Children below 2 years of age were seven patients and patients over 55 years of age were 8 patients. The male to female ratio was 3:2. Only five cases were nosocomially acquired. More than two-thirds (21 patients) had no discernible other illness at the time of their bacteremia. A quarter of the patients presented without gastrointestinal manifestation. There were four deaths in the 30 patients with nontyphi Salmonella septicemia (13.3%). CONCLUSIONS We investigated the clinical characteristics of 30 cases of non-typhi Salmonella bacteremia, which has a relatively high incidence nowadays while, to the contrary, Salmonella typhi trends toward being on the decrease in Korea.
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Affiliation(s)
- C B Ryu
- Department of Internal Medicine, Clinical Pathology, Soonchunhyang University Hospital, Seoul, Korea
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Stranks GJ, McLaren MI. Salmonella paratyphi--an unusual cause of primary septic arthritis of the hip. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1994; 26:489-90. [PMID: 7984984 DOI: 10.3109/00365549409008625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Salmonella paratyphi is an extremely rare cause of primary septic arthritis of the hip, especially in the U.K. The presentation is no different from other causative organisms. A case is described illustrating that uncommon organisms can cause septic arthritis and that for successful treatment correct organism identification is paramount.
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Affiliation(s)
- G J Stranks
- Department of Orthopaedics, Queen Alexandra Hospital, Portsmouth, Hampshire, England
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Widmer AF, Colombo VE, Gächter A, Thiel G, Zimmerli W. Salmonella infection in total hip replacement: tests to predict the outcome of antimicrobial therapy. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1990; 22:611-8. [PMID: 2259871 DOI: 10.3109/00365549009027105] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We report a hematogenous implant infection with Salmonella dublin in a renal transplant patient with total hip replacement. A 16-month treatment with cotrimoxazole failed, as evidenced by culture and electron microscopy, despite persisting low MIC after therapy. Data from a foreign body animal model and in vitro tests, which take into account the properties of adhering and stationary-phase bacteria, explain the failure of a long-term treatment with cotrimoxazole. The patient was subsequently cured by ciprofloxacin which was successful in these tests. No relapse was noted after a follow-up of 1 year.
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Affiliation(s)
- A F Widmer
- Department of Medicine, University Hospital, Basel, Switzerland
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Abstract
Infection in prosthetic devices is a rare but potentially serious complication of prosthesis implant surgery. Infections associated with a variety of permanently implanted devices are reviewed in the context of recent knowledge of the host-prosthesis interaction.
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Affiliation(s)
- E J Young
- Veterans Administration Medical Center, Houston, Texas
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