A Rare Periprosthetic Knee Joint Infection With Clostridium perfringens, the Result of 2-Stage Exchange Treatment: A Case Report and Review of Current Literature

Abstract

Prosthetic joint infections (PJIs) commonly result from aerobic gram-positive organisms and can lead to detrimental outcomes. However, it is rare for Clostridium perfringens to cause a PJI. Owing to its rarity, current literature lacks a comprehensive guide for the proper management of these PJIs. We report on the case of an 80-year old man who presented to our institution with concerns for sepsis secondary to a PJI with C. perfringens 25 years status post total knee arthroplasty. The patient was managed with two-stage revision and exchange. After stage one, the patient developed cholecystitis, which has been reported in prior cases of PJI due to C. perfringens. After concerns for sepsis had resolved and stage 1 was complete, the patient was managed with 6 weeks of IV antibiotics. Treatment was directed at gram-positives with IV vancomycin along with anerobic coverage determined by anerobic susceptibility testing. After the second stage, the patient was discharged with 3 months of oral antibiotic therapy. At the final 1-year follow-up, the patient was doing well without residual infection. This report reviews previous evidence on the management of C. perfringens PJI and presents a case demonstrating the successful diagnostic, surgical, and antimicrobial management of a PJI with C. perfringens.