Overwhelming septic infection with a multi-resistant Staphylococcus aureus (MRSA) after total knee replacement.
BACKGROUND
The incidence of early deep infection after arthroplasty of the knee is very low but could represent a serious future problem.


METHODS
The authors report on a 71-year-old woman with gonarthritis who was supplied with a total knee endoprosthesis and developed a local infection followed by septic shock.


RESULTS
The infection was evidently caused by a multiresistant Staphylococcus aureus (Staph. aureus). The primary clinical signs closely resembled a necrotizing fasciitis. Systemic and local application of vancomycin led to an improvement of the symptoms at secondary sites, but only the amputation of the primarily infected leg was lifesaving.


CONCLUSIONS
In order to prevent such events, the authors recommend a number of additional presurgical measures. Firstly, a swab from the nose and throat should be taken prior to an elective surgery in patients with elevated risk of immunodeficiency, for example in patients with diabetes. The diabetes should be adequately treated before an elective operation is undertaken. Secondly, an early punction of the knee joint should be carried out if there is any doubt regarding inflammation. Isolated infectious agents should be grounds for early revision, which should always be completed with a rinsing procedure and with adequate antibiotics. Immunotherapy should be taken into consideration. Antiepidemic measures are recommended in cases with known Staph. aureus.
Department of Orthopaedics, Rudolf-Elle Hospital, Friedrich-Schiller-University of Jena, Klosterlausnitzer Strasse 81, 07607 Eisenberg, Germany. ajroth@gmx.de
Andreas
A
Roth
Reneè
R
Fuhrmann
Martina
M
Lange
J
J
Mollenhauer
Eberhard
E
Straube
R
R
Venbrocks
D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007720:Knee Prosthesis / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000150:complications* / Q000175:diagnosis / Q000517:prevention & control; D012772:Shock, Septic / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000150:complications* / Q000175:diagnosis