SHM Converge Scientific Abstract ePoster Gallery-GPC Bacteremia? the Trials and Tribulations of Telehealth, Transfers, and Too Much Medicine

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This case describes a 59-year-old immunocompetent man with a remote left total knee arthroplasty who initially developed MRSA septic arthritis and underwent prosthesis removal with antibiotic spacer placement. He was treated with daptomycin but developed eosinophilic pneumonitis, requiring a switch to linezolid. Six months later, he underwent knee revision arthroplasty. One month after revision, he returned with knee pain, swelling, and purulent, malodorous drainage.<br /><br />He underwent operative debridement, fasciocutaneous flap coverage, and split-thickness skin grafting. Initial cultures were negative, but repeat anaerobic broth cultures later grew Bifidobacterium species, an uncommon anaerobic gram-positive rod usually considered part of the normal gut microbiome. Examination suggested superficial wound breakdown without clear periprosthetic joint involvement, indicating this was not a deep prosthetic joint infection. Based on limited literature and concern for atypical resistance patterns, including possible resistance to metronidazole and meropenem, he was treated with a short course of linezolid and amoxicillin-clavulanate.<br /><br />The case highlights several key points: prosthetic joint infections can lead to major morbidity, repeated surgeries, prolonged antibiotic exposure, and even amputation. Bifidobacterium is a rare but possible cause of postoperative musculoskeletal infection, even in patients without classic risk factors such as immunocompromise, probiotic use, or gastrointestinal disease. Its slow growth and anaerobic nature make it easy to miss on routine cultures, so extended incubation and broad diagnostic thinking are important when initial cultures are negative.<br /><br />The patient was later lost to orthopedic follow-up for over a year but eventually returned without signs of local or systemic infection. This case emphasizes the need to consider uncommon anaerobes in postoperative wound infections and to tailor antimicrobial therapy to the organism’s unusual susceptibility profile.

Asset Subtitle

Natalie Caylor

Meta Tag

Author List Anthony Daniels, David W. Walsh, Natalie Caylor

Category Clinical Vignettes

Concept Bifidobacterium

Concept Prosthetic Joint Infection

Concept Postoperative Surgical Site Infection

Concept Hematogenous Prosthetic Joint Infection

Concept Antimicrobial Therapy

Distinguished Non-Finalist

Presenter Organization Medical College of Georgia

Presenting Author Natalie Caylor

Track Adult

Keywords

Bifidobacterium

prosthetic joint infection

knee arthroplasty

MRSA septic arthritis

anaerobic infection

postoperative wound infection

linezolid

amoxicillin-clavulanate

culture-negative infection

split-thickness skin graft

Bifidobacterium

Prosthetic Joint Infection

Postoperative Surgical Site Infection

Hematogenous Prosthetic Joint Infection

Antimicrobial Therapy