Fatal Clostridium Infection in a Leg-Amputated Patient after Unsuccessful Knee Arthroplasty

Enrico Maria Zardi, Paolo Persichetti, Alessio Palumbo, Edoardo Franceschetti and Francesco Franceschi
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Enrico Maria Zardi: Internistic Ultrasound Service, Campus Bio-Medico University, 00128 Rome, Italy
Paolo Persichetti: Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, 00128 Rome, Italy
Alessio Palumbo: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, 00128 Rome, Italy
Edoardo Franceschetti: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, 00128 Rome, Italy
Francesco Franceschi: Department of Orthopaedic and Trauma Surgery, San Pietro Fatebenefratelli Hospital, 00189 Rome, Italy

IJERPH, 2021, vol. 18, issue 17, 1-7

Abstract: 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.

Keywords: amputation; antibiotic; clostridium infection; prosthesis; skin wound; therapy (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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