Achromobacter xylosoxidans Infection Following Arthroscopic Bankart Repair in an Immunocompetent Patient: A Case Report

Arthroscopic Bankart repair is the most commonly performed procedure for treating anterior shoulder instability. Achromobacter xylosoxidans, an aerobic, Gram-negative bacillus, is a rare cause of infection in immunocompetent individuals. Here, we present the case of a 28-year-old male who presented with right shoulder discomfort and a discharging sinus tract eight years after undergoing an arthroscopic Bankart repair. He was treated with arthroscopic debridement and sinus tract excision at another hospital before presenting to us, but the symptoms had recurred within two weeks. Imaging confirmed the presence of a sinus tract communicating with the antero-inferior glenoid rim, with a cystic lesion at the site of the implanted anchors. Under general anesthesia, an open debridement of the right shoulder was undertaken. Osteolysis was noted, and two loose all-suture anchors were removed. Surrounding bone and soft tissue samples were sent for microbiological testing, and antibiotic-impregnated cement beads were placed in the glenoid defect after a thorough lavage. Culture reports revealed A. xylosoxidans growth, and culture-directed antibiotics were administered after consulting the infectious disease team. At the two-month follow-up, he was symptom-free, and the sinus tract had completely healed. He had full shoulder function with no signs of infection at the one-year follow-up. This case highlights the need to consider rare, multidrug-resistant pathogens as a cause of postoperative infections, even after minimally invasive procedures in immunocompetent individuals. A high index of suspicion is essential, especially for indolent infections. Early diagnosis, complete hardware removal, and targeted antibiotic therapy are critical for successful outcomes. Additionally, infection with atypical organisms in healthy individuals points toward a probable shift in the pathogenicity of these organisms. To the best of our knowledge, this is the first reported case of A. xylosoxidans infection involving the shoulder joint and the first instance of this infection occurring after an arthroscopic procedure.