A novel case of prosthetic joint infection due to Clostridioides difficile successfully suppressed with oral doxycycline

Extra-colonic infections caused by Clostridioides difficile are exceptionally rare, with prosthetic joint infections (PJIs) comprising only a small fraction of the reported cases. Moreover, there is limited guidance on the optimal management of such infections. We present the case of a 76-year-old man who developed a left hip PJI due to C. difficile 6 weeks after undergoing surgical revision for a periprosthetic fracture. Given the complexity of the case, curative surgical intervention was not considered feasible. The patient was treated with repeated debridement, intravenous vancomycin and oral (PO) metronidazole, followed by successful suppression with PO doxycycline – a novel therapeutic approach not previously documented. To date, only seven cases of C. difficile -associated PJI have been reported in the literature; this is the first known instance in which suppression of a C. difficile PJI has been achieved and the first to utilize whole-genome sequencing for further analysis of the isolate.