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Internal Medicine
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Clinical Science
Abstract
Introduction: Collectively, over 1 million total knee arthroplasties (TKA) and total hip arthroplasties (THA) are performed in the United States each year. In 2010 it was estimated that 1.58% of the United States general population has received a TKA. Prosthetic joint infections (PJI) are the most common indication for a TKA revision1 . In total, S. aureus is responsible for about 50% of all prosthetic joint infections, and about 15% are caused by gram negative pathogens2 .
Objective: This is a case report which describes the presentation and clinical course of a 59-yearold female with Salmonella enterica septic arthritis of a prosthetic right knee.
Methods: On 10/13/2020, the patient received an x-ray of the right knee, arthrocentesis with bacterial cultures and sensitivities, and was discharged. Patient was admitted on 10/15/2020 and was started on levofloxacin 750mg. On day three the orthopedic surgeon performed a right knee arthrotomy, complete synovectomy, removal of infected total knee arthroplasty components, and placement of an antibiotic cement spacer.
Results: Patient is a 59-year-old Hispanic female with a past medical history significant for rheumatoid arthritis, who takes methylprednisolone daily, and bilateral knee replacements who presented to the ED 7 days after tripping over a pipe and landing on her right knee, and endorsed pain, warmth, and swelling. The patient returned to the ED 10/15/2020 after cultures came back positive for Salmonella enterica. The patient did not show signs of systemic infection. On 10/17/2020 the orthopedic surgeon performed a right knee arthrotomy, complete synovectomy, removal of infected total knee arthroplasty components, and placement of an antibiotic cement spacer without complications. A peripherally inserted central catheter was placed on 10/17/2020 for administration of long term-antibiotics. On 10/20/2020 the patient was discharged to a nursing facility for antibiotic administration and physical rehabilitation.
Discussion: Over 44 years, the Mayo Clinic only identified 6 cases of prosthetic joint infection caused by Salmonella, 5 of those patients were immunosuppressed3 . Salmonella PJI has also been observed in patients taking a prednisolone and azathioprine regimen4 . The infection is thought to spread hematogenously, likely following gastroenteritis, however GI illness was not observed in our patient. Although the Salmonella PJI can present years after arthroscopy, it has also been observed to occur within days of an arthroscopy 5.
Conclusions: Salmonella enterica is a very rare pathogen responsible for prosthetic joint infection.
Presentation Type
Poster
Recommended Citation
Ramos, Carlos; Appareddy, Shyama; and Gonzalez, Peter J., "Rare Case of Prosthetic Joint Infection Caused by Salmonella enterica - A Case Report" (2023). Research Colloquium. 43.
https://scholarworks.utrgv.edu/colloquium/presentation/poster/43
Included in
Bacterial Infections and Mycoses Commons, Infectious Disease Commons, Internal Medicine Commons, Medical Microbiology Commons, Orthopedics Commons
Rare Case of Prosthetic Joint Infection Caused by Salmonella enterica - A Case Report
Introduction: Collectively, over 1 million total knee arthroplasties (TKA) and total hip arthroplasties (THA) are performed in the United States each year. In 2010 it was estimated that 1.58% of the United States general population has received a TKA. Prosthetic joint infections (PJI) are the most common indication for a TKA revision1 . In total, S. aureus is responsible for about 50% of all prosthetic joint infections, and about 15% are caused by gram negative pathogens2 .
Objective: This is a case report which describes the presentation and clinical course of a 59-yearold female with Salmonella enterica septic arthritis of a prosthetic right knee.
Methods: On 10/13/2020, the patient received an x-ray of the right knee, arthrocentesis with bacterial cultures and sensitivities, and was discharged. Patient was admitted on 10/15/2020 and was started on levofloxacin 750mg. On day three the orthopedic surgeon performed a right knee arthrotomy, complete synovectomy, removal of infected total knee arthroplasty components, and placement of an antibiotic cement spacer.
Results: Patient is a 59-year-old Hispanic female with a past medical history significant for rheumatoid arthritis, who takes methylprednisolone daily, and bilateral knee replacements who presented to the ED 7 days after tripping over a pipe and landing on her right knee, and endorsed pain, warmth, and swelling. The patient returned to the ED 10/15/2020 after cultures came back positive for Salmonella enterica. The patient did not show signs of systemic infection. On 10/17/2020 the orthopedic surgeon performed a right knee arthrotomy, complete synovectomy, removal of infected total knee arthroplasty components, and placement of an antibiotic cement spacer without complications. A peripherally inserted central catheter was placed on 10/17/2020 for administration of long term-antibiotics. On 10/20/2020 the patient was discharged to a nursing facility for antibiotic administration and physical rehabilitation.
Discussion: Over 44 years, the Mayo Clinic only identified 6 cases of prosthetic joint infection caused by Salmonella, 5 of those patients were immunosuppressed3 . Salmonella PJI has also been observed in patients taking a prednisolone and azathioprine regimen4 . The infection is thought to spread hematogenously, likely following gastroenteritis, however GI illness was not observed in our patient. Although the Salmonella PJI can present years after arthroscopy, it has also been observed to occur within days of an arthroscopy 5.
Conclusions: Salmonella enterica is a very rare pathogen responsible for prosthetic joint infection.