Staged Reimplantation of a Total Hip Prosthesis After Co-infection with Candida tropicalis and Staphylococcus haemolyticus: A Case Report.

Publisher: Kluwer Academic Country of Publication: Netherlands NLM ID: 7505689 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1573-0832 (Electronic) Linking ISSN: 0301486X NLM ISO Abbreviation: Mycopathologia Subsets: MEDLINE

Publication: Dordrecht : Kluwer Academic
Original Publication: [The Hague, W. Junk]

Arthroplasty, Replacement, Hip*; Candida tropicalis/*isolation & purification ; Candidiasis/*diagnosis ; Coinfection/*diagnosis ; Prosthesis-Related Infections/*therapy ; Staphylococcal Infections/*diagnosis ; Staphylococcus haemolyticus/*isolation & purification; Anti-Infective Agents/administration & dosage ; Candida tropicalis/classification ; Candidiasis/therapy ; Coinfection/therapy ; DNA, Bacterial/chemistry ; DNA, Bacterial/genetics ; DNA, Fungal/chemistry ; DNA, Fungal/genetics ; DNA, Ribosomal/chemistry ; DNA, Ribosomal/genetics ; Debridement ; Humans ; Male ; Middle Aged ; Prosthesis-Related Infections/diagnosis ; RNA, Ribosomal, 16S/genetics ; RNA, Ribosomal, 18S/genetics ; Replantation ; Sequence Analysis, DNA ; Staphylococcal Infections/therapy ; Staphylococcus haemolyticus/classification ; Treatment Outcome

Fungal prosthetic joint infection is a rare complication in total joint arthroplasty. There are no established guidelines for management of these infections. We present a case of a 53-year-old male with a hip joint prosthesis co-infected with Candida tropicalis and Staphylococcus haemolyticus. A two-stage exchange arthroplasty was performed. The patient underwent implant removal, debridement, irrigation with saline solution and application of cement spacer impregnated with vancomycin followed by aggressive antimicrobial treatment in first stage. Complete eradication of infection was demonstrated by negative culture of sonicated cement spacer fluid and negative 16S rRNA and 18S rRNA gene PCR of sonicate fluid, synovial fluid and periprosthetic tissue samples. He underwent second-stage revision hip arthroplasty after 9 months of the first stage. At the latest follow-up, there was no evidence of recurrence of infection. This case illustrates the utility of sonication of biomaterials and molecular techniques for microbiological confirmation of absence of infection in staged surgeries which is required for a successful outcome.

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Keywords: Antibiotic-impregnated cement spacers; Prosthetic joint infection; Sonication of biomaterials

0 (Anti-Infective Agents)
0 (DNA, Bacterial)
0 (DNA, Fungal)
0 (DNA, Ribosomal)
0 (RNA, Ribosomal, 16S)
0 (RNA, Ribosomal, 18S)

Date Created: 20170724 Date Completed: 20180924 Latest Revision: 20220410

20231215

10.1007/s11046-017-0177-x

28735470