Salmonella infection in total hip replacement: tests to predict the outcome of antimicrobial therapy.
We report a hematogenous implant infection with Salmonella dublin in a renal transplant patient with total hip replacement. A 16-month treatment with cotrimoxazole failed, as evidenced by culture and electron microscopy, despite persisting low MIC after therapy. Data from a foreign body animal model and in vitro tests, which take into account the properties of adhering and stationary-phase bacteria, explain the failure of a long-term treatment with cotrimoxazole. The patient was subsequently cured by ciprofloxacin which was successful in these tests. No relapse was noted after a follow-up of 1 year.
Widmer
A F
AF
Department of Medicine, University Hospital, Basel, Switzerland.
Colombo
V E
VE
Gächter
A
A
Thiel
G
G
Zimmerli
W
W
D000328:Adult; D000658:Amoxicillin / Q000494:pharmacology; D000818:Animals; D001170:Arthritis, Infectious / Q000188:drug therapy*; D001422:Bacterial Adhesion; D002939:Ciprofloxacin / Q000494:pharmacology / Q000627:therapeutic use*; D015194:Diffusion Chambers, Culture; D004195:Disease Models, Animal; D006168:Guinea Pigs; D006622:Hip Prosthesis; D006801:Humans; D007165:Immunosuppression Therapy; D008297:Male; D008826:Microbial Sensitivity Tests; D008855:Microscopy, Electron, Scanning; D012475:Salmonella / Q000187:drug effects / Q000648:ultrastructure; D012480:Salmonella Infections / Q000188:drug therapy*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology / Q000627:therapeutic use*
D002939:Ciprofloxacin; D000658:Amoxicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination