Prosthetic joint infection due to Salmonella species: a case series

Abstract

Background: Prosthetic joint infection (PJI) due to Salmonella is rare. Numerous outbreaks of Salmonella have been reported throughout the United States in the last decade. We reviewed and analyzed cases of Salmonella PJI seen at our institution.

Methods: The medical records of all patients diagnosed with a Salmonella PJI between 1969-2013 were reviewed. Patients were followed till death, treatment failure or loss to follow-up.

Results: Six patients of Salmonella PJI were identified during the 44 year study period. Five were male; median age was 63.5 years (range 52-76). Five patients were immunodeficient. Five had a total hip arthroplasty infection, while one had a total knee arthroplasty infection. Median prosthesis age at the time of diagnosis of first episode of Salmonella PJI was 5 years (range 4 months-9 years). Four presented with fever and constitutional signs within two weeks of symptom onset. Two patients each had gastrointestinal symptoms and Salmonella bacteremia. Salmonella enterica serovar Enteritidis was the most common organism isolated (4 patients). None were Salmonella enterica serovar Typhi. Initial management included aspiration and antimicrobial therapy only (3), debridement and component retention (1) and two-staged exchange (2). All four patients treated without resection failed treatment a median of 2.5 months (range 2-11) after diagnosis and required resection arthroplasty. All six patients who underwent prosthesis removal (and exchange or arthrodesis) had successful outcome with a median duration of follow-up of 11 years (range 4-21). Three of these received oral antimicrobial therapy for a median duration eight weeks (range 4-8) and three received parenteral antimicrobial therapy for a median duration of six weeks (range 4-6).

Conclusions: The increase in Salmonella outbreaks does not seem to lead to increased Salmonella PJI. PJIs due to Salmonella remain rare, and the presentation is often acute with fever. It frequently occurs in immunocompromised patients. In our patient population, removal of prosthesis with or without reimplantation, along with 4-6 weeks of effective parenteral antimicrobial therapy was most often associated with successful eradication of infection.