Septic arthritis of the hip caused by nontyphi Salmonella after urinary tract infection

Acute multifocal osteomyelitis with septic arthritis caused by nontyphoidal Salmonella in an immunocompetent young adult: a case report

Nontyphoidal Salmonella (NTS) infection can lead to gastroenteritis, enteric fever, and bacteremia. However, bone and joint infections due to NTS are rarely encountered, accounting for only 0.8% of all Salmonella infections and 0.45% of all types of osteomyelitis. We herein report an extremely rare case of acute multifocal osteomyelitis (bilateral femurs and left tibia) with septic arthritis of the bilateral hips caused by Salmonella Dublin in an immunocompetent adult. We performed thorough debridement of the bilateral hips and surgical decompression of the involved bones. At 1 year of follow-up, the patient's inflammatory biomarkers were within normal limits, and clinical and radiologic examinations showed no signs of infection. We emphasize that invasive NTS can lead to multifocal bone and joint infections in immunocompetent adults. The manifestations of Salmonella osteomyelitis may be insidious; thus, we recommend performing a simultaneous magnetic resonance imaging examination of the bone adjacent to the infected joint to avoid missed or delayed diagnosis. Thorough surgical debridement combined with a long course of sensitive antibiotic therapy is essential to eradicate the infection.

Septic arthritis with osteomyelitis due to Salmonella enterica serotype Dublin: A case series

Background

Septic arthritis with osteomyelitis due to Salmonella enterica serotype Dublin is rare. We reviewed and analyzed cases of septic arthritis with osteomyelitis due to Salmonella enterica serotype Dublin seen at our institution.

Methods

The medical records of all patients diagnosed with Salmonella septic arthritis and/or Salmonella osteomyelitis during 2017-2022 were included. We reviewed the diagnosis, medical history, clinical management, and outcome of all cases.

Results

Five patients with Salmonella septic arthritis or Salmonella osteomyelitis were identified during the 5-year study period. They were all male; the median age was 53 years (range 15-56). Only one was immunodeficient. All five patients were infected at the hip joint and ipsilateral femur, while two suffered bilateral hip septic arthritis with femoral osteomyelitis. Salmonella Dublin was isolated from the hip joint fluid of all patients. Four presented with fever and constitutional signs within four weeks of symptom onset. Four had positive blood cultures, and only one patient had gastrointestinal symptoms. Four patients underwent surgical debridement as the primary surgical plan, and two underwent secondary two-stage exchange after primary surgical debridement failure. The last patient had a two-stage exchange directly as the first surgical treatment. All patients received intravenous antimicrobial therapy for a median duration of 6 (range 4-12) weeks and oral antimicrobial therapy for a median duration of 4 (range 4-6) weeks. All patients had a median duration of follow-up of 12 months (range 9-25), and none had evidence of recurrence of infection.

Conclusions

Septic arthritis due to Salmonella Dublin remains rare. It frequently occurs with ipsilateral femur osteomyelitis adjacent to the infected hip joint in our cases. Surgical debridement or two-stage exchange, along with 4-12 weeks of effective intravenous and followed by 4-6 oral antimicrobial therapy, could successfully eradicate the infection.

Bilateral Salmonella Septic Arthritis of the Hip in a Patient with Crohn Disease: A Case Report

CASE

A 27-year-old immunocompromised man with Crohn disease presented with bilateral septic hip arthritis due to Salmonella enterica serotype Typhi. The diagnosis was confirmed by synovial membrane and effusion culture specimens that were obtained during arthroscopic debridement of both hips.

CONCLUSION

Prolonged antimicrobial therapy, bilateral femoral head resection, and placement of cement spacers for 5 months, followed by bilateral total hip arthroplasty, was a radical and effective treatment for a patient with Crohn disease and bilateral Salmonella septic arthritis of the hip.

Dislocation of preformed antibiotic-loaded cement spacers (Spacer-G): etiological factors and clinical prognosis

This study assesses the factors associated with the dislocation of the Spacer-G and its clinical prognosis. Seventy-four spacers were reviewed. Acetabular bone defects, proximal femoral cementation of the spacer and its relationship to the size of the head spacer were not associated with dislocation. The only variable that it was possible to associate with dislocation was when the previous stem, prior to the spacer placement, was a cemented stem. In patients who experienced a dislocation, infection was not cured during the interim period more frequently than patients who had not experienced a dislocation (P = 0.001) and the final clinical hip evaluation was also worse (P < 0.001). The study concludes that the surgeon should assess different surgical aspects in order to avoid mechanical complications such as dislocation and its consequences.

Radiological evaluation of acetabular erosion after antibiotic-impregnated polymethylmethacrylate spacer (Spacer-G)

Different types of hip spacers have been described (hand-made, custom-molded or prefabricated) for treatment of a chronic hip infection. A potential disadvantage of monoblock prefabricated spacer is that it may cause acetabular bone loss. This study assesses the radiological acetabular erosion using an antibiotic-impregnated pre-fabricated polymethylmethacrylate Spacer-G. We retrospectively reviewed the radiographs of thirty five patients who were managed with Spacer-G to treat chronic hip infection. No acetabular erosion were observed in thirty two patients with a mean time from the first to second stage and from the first to the last radiograph of 5.09 and 3.77 months respectively. In three patients the time between the radiographs was more than one year and the second stage was not performed; two developed a protrusion acetabuli whereas the other one a destruction of the acetabular roof. Using a Spacer-G in chronic hip infection treatment for less than one year is not associated with radiological acetabular erosion if the patient is maintained at partial weight bearing.