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Fatal Clostridium Infection in a Leg-Amputated Patient after Unsuccessful Knee Arthroplasty
Prosthetic joint infection (PJI) is a possible complication occurring after prosthesis implantation. We describe the case of a patient with early postoperative multidrug-resistant polymicrobial PJI and mixed infection of the surgical wound. Despite the removal of the prosthesis, the positioning of d...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430686/ https://www.ncbi.nlm.nih.gov/pubmed/34501775 http://dx.doi.org/10.3390/ijerph18179186 |
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author | Zardi, Enrico Maria Persichetti, Paolo Palumbo, Alessio Franceschetti, Edoardo Franceschi, Francesco |
author_facet | Zardi, Enrico Maria Persichetti, Paolo Palumbo, Alessio Franceschetti, Edoardo Franceschi, Francesco |
author_sort | Zardi, Enrico Maria |
collection | PubMed |
description | Prosthetic joint infection (PJI) is a possible complication occurring after prosthesis implantation. We describe the case of a patient with early postoperative multidrug-resistant polymicrobial PJI and mixed infection of the surgical wound. Despite the removal of the prosthesis, the positioning of double-stage exchange, and dehiscence debridement of the surgical wound, the infection continued. Positioning of an external fixator, plastic reconstruction with a skin graft, and continuous (two years) multiple antimicrobial therapy led to the resolution of the knee infection; a knee prosthesis was implanted, but a new infection of the extensus apparatus by multidrug-resistant Klebsiella pnumoniae followed. It was complicated by surgical wound dehiscence, forcing us to remove the prosthesis, put a new external fixator, and continue with the antibiotic treatment, with no results, and, finally, proceed to a leg amputation. Fourteen days after, the patient was discharged in good clinical condition but, fifteen days later, during rehabilitation in another hospital, the patient developed a severe Clostridium difficilis infection with profuse, intense diarrhea, toxic megacolon, and septic shock; despite colectomy and treatment in an intensive care unit, he died four months later. Patients affected by polymicrobial PJI are at high risk of treatment failure and, therefore, should be given a warning, in good time and appropriate form, of the likelihood of leg amputation. |
format | Online Article Text |
id | pubmed-8430686 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-84306862021-09-11 Fatal Clostridium Infection in a Leg-Amputated Patient after Unsuccessful Knee Arthroplasty Zardi, Enrico Maria Persichetti, Paolo Palumbo, Alessio Franceschetti, Edoardo Franceschi, Francesco Int J Environ Res Public Health Case Report Prosthetic joint infection (PJI) is a possible complication occurring after prosthesis implantation. We describe the case of a patient with early postoperative multidrug-resistant polymicrobial PJI and mixed infection of the surgical wound. Despite the removal of the prosthesis, the positioning of double-stage exchange, and dehiscence debridement of the surgical wound, the infection continued. Positioning of an external fixator, plastic reconstruction with a skin graft, and continuous (two years) multiple antimicrobial therapy led to the resolution of the knee infection; a knee prosthesis was implanted, but a new infection of the extensus apparatus by multidrug-resistant Klebsiella pnumoniae followed. It was complicated by surgical wound dehiscence, forcing us to remove the prosthesis, put a new external fixator, and continue with the antibiotic treatment, with no results, and, finally, proceed to a leg amputation. Fourteen days after, the patient was discharged in good clinical condition but, fifteen days later, during rehabilitation in another hospital, the patient developed a severe Clostridium difficilis infection with profuse, intense diarrhea, toxic megacolon, and septic shock; despite colectomy and treatment in an intensive care unit, he died four months later. Patients affected by polymicrobial PJI are at high risk of treatment failure and, therefore, should be given a warning, in good time and appropriate form, of the likelihood of leg amputation. MDPI 2021-08-31 /pmc/articles/PMC8430686/ /pubmed/34501775 http://dx.doi.org/10.3390/ijerph18179186 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Case Report Zardi, Enrico Maria Persichetti, Paolo Palumbo, Alessio Franceschetti, Edoardo Franceschi, Francesco Fatal Clostridium Infection in a Leg-Amputated Patient after Unsuccessful Knee Arthroplasty |
title | Fatal Clostridium Infection in a Leg-Amputated Patient after Unsuccessful Knee Arthroplasty |
title_full | Fatal Clostridium Infection in a Leg-Amputated Patient after Unsuccessful Knee Arthroplasty |
title_fullStr | Fatal Clostridium Infection in a Leg-Amputated Patient after Unsuccessful Knee Arthroplasty |
title_full_unstemmed | Fatal Clostridium Infection in a Leg-Amputated Patient after Unsuccessful Knee Arthroplasty |
title_short | Fatal Clostridium Infection in a Leg-Amputated Patient after Unsuccessful Knee Arthroplasty |
title_sort | fatal clostridium infection in a leg-amputated patient after unsuccessful knee arthroplasty |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8430686/ https://www.ncbi.nlm.nih.gov/pubmed/34501775 http://dx.doi.org/10.3390/ijerph18179186 |
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