Failed Reverse Total Shoulder Arthroplasty Caused by RecurrentCandida glabrataInfection with PriorSerratia marcescensCoinfection

Abstract

This report describes a 58-year-old insulin-dependent diabetic male patient who initially sustained a proximal humerus fracture from a fall. The fracture fixation failed and then was converted to a humeral hemiarthroplasty, which became infected withCandida glabrataandSerratia marcescens. After these infections were believed to be cured with antibacterial and antifungal treatments and two-stage irrigation and debridement, he underwent conversion to a reverse total shoulder arthroplasty. Unfortunately, theC. glabratainfection recurred and, nearly 1.5 years after implantation of the reverse total shoulder, he had a resection arthroplasty (removal of all implants and cement). His surgical and pharmacologic treatment concluded with (1) placement of a tobramycin-impregnated cement spacer also loaded with amphotericin B, with no plan for revision arthroplasty (i.e., the spacer was chronically retained), and (2) chronic use of daily oral fluconazole. We located only three reported cases ofCandidaspecies causing infection in shoulder arthroplasties (twoC. albicans, oneC. parapsilosis). To our knowledge, a total shoulder arthroplasty infected withC. glabratahas not been reported, nor has a case of aC. glabrataandS. marcescensperiprosthetic coinfection in any joint. In addition, it is well known thatS. marcescensinfections are uncommon in periprosthetic joint infections.