Clostrium perfringes infection of a Total Knee ArthroplastyCase Report and Review of the Literature

摘要

C. perfringes is a gram positive anaerobic pathogen that is usually associated with skin and soft tissue infections, gastrointestinal infections and occasionally bacteremia. Arthroplasty infections associated with c. perfringes have been rarely reported with most of them being associated with bacteremia. We present a case of de novo C. perfringes infection in a patient with a total knee arthroplasty (TKA) without associated bacteremia. Case Report This is a 56-year-old white male with a history of a (TKA) done 13 years ago who underwent a revision of the knee due to malfunctioning of the arthroplasty. Two weeks following the surgery he developed increasing pain and tenderness over the incision site associated with low-grade fever and chills and subsequently developed an abscess over the incision site. On admission he had a temperature of 100.1F,blood pressure of 124/78 mm Hg and pulse of 79/mt. The clinical exam was significant only for swelling and tenderness to the knee with an abscess over the incision. The size of the abscess was 2”x3” which contained blood stained fluid. The patient underwent an incision and debridement of the abscess and cultures grew C. perfringes sensitive to clindamycin (MIC 0.5) but resistant to penicillin. Labs included a white blood cell count of 6.7x 10E/ul, ESR 76 and CRP 7.6. The remaining labs were unremarkable. A complete work up was done to identify the primary source of the infection including colonoscopy; ultrasound of the liver and spleen and blood cultures but no source was identified. He then underwent removal of the arthroplasty. He had to undergo repeated wash outs of the site due to the extent of the infection and was treated with cefepeme (MIC0.25) and oral clindamycin for 4 weeks. Follow up in the office 6 months and 1 year later, revealed normalization of the ESR and CRP and complete healing of the wound.