Haematogenous infection of a resurfacing hip replacement after transurethral resection of the prostate

Abstract

A 66-year-old man presented with an infected resurfacing hip replacement in the immediate post-operative period following an uneventful transurethral resection of the prostate. Prophylactic antibiotics had been administered on induction of anaesthesia. The hip prosthesis had been inserted seven years previously and had been hitherto asymptomatic. The hip was washed out and microbiological examination identified Enterococcus faecalis as the infecting micro-organism. Despite current recommendations, clinicians undertaking invasive procedures which can lead to bacteraemia in patients with prosthetic joint replacements should be aware of the risk of haematogenous seeding in such prostheses, which although low, has potentially disastrous consequences.

Genitourinary Procedures as Risk Factors for Prosthetic Hip or Knee Infection: A Hospital-Based Prospective Case-Control Study

“…Only 24 of these 1000 patients underwent such a procedure, and none developed PJI. A case of Enterococcus faecalis TKA infection immediately after TURP occurred despite sterile preoperative urine and appropriate antibiotic prophylaxis, raising the question of the ability of prophylaxis to protect against these rare infections [ 10 ]. The 4 cases in our study that had undergone a procedure on the prostate in the last 2 years had infection with either S aureus or S epidermidis ; organisms not associated with the GU tract of humans.…”

“…Whether procedure-related bacteremia is enough to cause PJI is unknown. A small number of case reports of PJI after GU procedures have been reported; the link is mostly based on circumstantial evidence [ 10 , 11 ].…”

Acupuncture needle-associated prosthetic knee infection after total knee arthroplasty

“…Possible sources for this bacterium are the oral cavity and gastrointestinal and urogenital tracts. To date, only two cases demonstrating prosthetic joint infection caused by E. faecalis have been reported in the literature [15,16]. One of these is hematogenous infection of a resurfacing hip replacement after transurethral resection of the prostate [16].…”

“…To date, only two cases demonstrating prosthetic joint infection caused by E. faecalis have been reported in the literature [15,16]. One of these is hematogenous infection of a resurfacing hip replacement after transurethral resection of the prostate [16]. As the hip prosthesis had been inserted 7 years before surgery and had been asymptomatic with no other significant comorbidities, this case is thought to be that of a late infection.…”