Salmonella enteritidis : a rare pathogen in a polymicrobial acute prosthetic joint infection following total hip arthroplasty treated with double debridement, antibiotics, and implant retention (DAIR)

Prosthetic joint infection (PJI) with Salmonella enteritidis is rare following orthopedic surgery and joint arthroplasty. This is a case of a 77-year-old female with left femoral transcervical fracture underwent total hip arthroplasty. At 2-weeks follow-up, the patient developed a PJI that was treated with double debridement, antibiotics, and implant retention (DAIR). Intraoperative cultures revealed unusual S. enteritidis without a primary focus of infection as part of polymicrobial PJI. She received a 3-month course of antibiotics including per os (PO) azithromycin and intravenous (IV) ceftriaxone that was switched to IV meropenem. At last follow-up, infection had resolved, inflammatory markers normalized, there was no evidence of prosthetic loosening and the patient was ambulatory. Salmonella organism is an atypical isolate in PJI. In the absence of a primary cause and in the context of acute infection, double DAIR is a viable option to salvage the prosthesis when a dual approach of aggressive intraoperative debridement and postoperative antibiotics coverage is employed.