Clostridium cadaveris Septic Arthritis After Total Right Hip Arthroplasty in an Immunocompetent Host

Abstract

An elderly woman underwent an uncomplicated right hip replacement (total hip arthroplasty) in 2005 and returned 5 years later with cellulitis of the right hip. Treatment with oral antibiotics was initiated. Septic arthritis of the right hip joint was diagnosed ultimately, and she had surgical removal (explant) of the right hip prosthesis in 2011. Recurrent right hip infections ensued on several occasions with multiple antibiotic courses over the next 4 years. Although she had intermittent infections with methicillin-susceptible Staphylococcus aureus and methicillin-resistant Staphylococcus aureus, she had consistent and persistent isolation of Clostridium cadaveris from the hip beginning in 2013. After prolonged surgical interventions and several courses of antibiotics, C. cadaveris was eradicated; she has undergone implantation for a second stage implant (total hip arthroplasty) of the affected hip and remains stable to date.

In Brief

The incidence of anaerobic prosthetic infections is uncommon to rare. Success rates vary as do the antibiotic susceptibilities of responsible microbes. Clostridium cadaveris, an anaerobe, was responsible for recurrent and persistent infection of a prosthetic hip in a woman with no underlying immunocompromise, and required multiple surgeries and antibiotic courses for eradication. Reasons for the difficulty at eradication remain unclear but may be due to antibiotic delivery issues, bacterial killing potential of antibiotics, and biofilm characteristics.