Prosthetic hip infection with Edwardsiella tarda in sickle cell beta thalassemia disease: A case report

Abstract

Periprosthetic infection following total hip arthroplasty is a devastating complication that has been reported to occur in up to 1.6% of all primary total hip arthroplasties. We report a previously unrecognized gram-negative bacillus as the infecting agent in a patient with bilateral total hip arthroplasties for stage IV osteonecrosis. A 22-year-old male with combined sickle cell disease and beta thalassemia with a prior history of unknown hip surgeries and treatment for distal tibial osteomyelitis in Africa developed a periprosthetic joint infection; intra-operative cultures confirmed the infecting organism to be Edwardsiella tarda which was sensitive to late-generation cephalosporins and vancomycin. He was successfully treated with a staged revision total hip arthroplasty with an antibiotic spacer and has been infection-free since. E. tarda is a gram-negative bacillus which has not been previously associated with periprosthetic infection following TJA. This organism infects both humans and fish, and is particularly associated with commercial fishing and fish farming of freshwater and marine fish, potentially putting workers in these industries at risk. Little is known about antibacterial resistance in this organism. Infection by E. tarda presents a new organism which may affect individuals undergoing TJA, particularly if they have medical comorbidities that increase their risk for infection, or work in industries which put them at a higher risk of infection by this organism. Further study on the antimicrobial resistance patterns of this organism will be required to be able to treat potentially resistant organisms.

Keywords: Beta thalassemia; Edwardsiella tarda; Periprosthetic infections; Sickle cell; Total hip arthroplasty.

Fig. 1

(A) Preoperative evaluation; (B) original post-total hip arthroplasty; (C) prosthetic removal, irrigation and debridement, and antibiotic spacer; and (D) 1-year follow-up post-revision total hip arthroplasty.