First case of periprosthetic joint infection due to Clostridioides difficile in China

Yang Song,Yang Song,Xiang Cheng,Xiang Cheng,Hong Yi Shao,Hong Yi Shao,Yu Guo

doi:10.1186/s12879-021-06171-y

Yang Song, Yang Song + Show 5 more

Open Access

https://doi.org/10.1186/s12879-021-06171-y

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Abstract

BackgroundClostridioides difficile usually causes intestinal infections. However, a 75-year-old lady had a periprosthetic joint infection due to this microorganism. We report a C. difficile infection of a prosthetic hip joint. Such an infection is rarely reported around the world.Case presentationThe elder female patient presented with a 2-year history of right hip pain with movement restriction. Her right leg was shorter than another. The skin around the right hip joint was red and swollen without sinus. Her lab test result showed elevator ESR and CRP. Her X-ray film showed a massive bone defect. The patient had a total hip arthroplasty 16 years ago and had a revision 5 years ago. During this hospitalization, her cultures of the synovial fluid and tissue repeatedly grew C. difficile. She improved following two-stage revision surgery and antibiotic treatment. The patient has no recurrence of infection after a one-year follow-up.ConclusionA rapid and accurate sample collection is significant for culture results, making an outstanding contribution to the successful treatment.

Highlights

Gram-positive cocci constitute more than two-thirds of the pathogenic organisms in periprosthetic joint infection (PJI); other cases involve Gram-negative bacteria, fungi, or other organisms [3]
We report the first known case of PJI caused by C. difficile after Total hip arthroplasty (THA) in China and describe the isolation technique and treatment of this microorganism
Cultures of all samples showed no growth, and the patient underwent another round of antibiotic treatment (2 weeks of intravenous metronidazole and another 4 weeks of oral metronidazole, as before). She returned for regular follow-ups. At her latest follow-up, 1 year after the diagnosis of PJI due to C. difficile, her right hip was pain-free, and the incision had healed without clinical signs of infection

Summary

Introduction

Conclusion: A rapid and accurate sample collection is significant for culture results, making an outstanding contribution to the successful treatment. Clostridioides difficile is a spore-forming, toxinproducing Gram-positive anaerobe, which usually causes intestinal infections, has rarely been reported in cases of PJI. * Correspondence: muyuyuyu@yeah.net 2Department of Microbiology and Molecule Laboratory, Jishuitan Hospital and Fourth Medical College of Peking University, 31 East Street, Xinjiekou, Xicheng District, Beijing 100035, CN, China Full list of author information is available at the end of the article difficile is well culturable.

Results

Conclusion