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Abstract: The patient, Brother Wang, underwent artificial hip arthroplasty 1 year ago. 3 months after the operation, the wound was red, swollen, ulcerated, purulent and painful, and the effect of debridement and drug replacement was poor. After secretion culture, it was suggested that Salmonella typhimurium infection occurred in the artificial hip arthroplasty wound, which is a kind of Salmonella infection. After anti-infection treatment with sensitive antibiotics and replacement of the artificial hip joint, the patient’s wound completely healed, no purulent discharge, pain improved significantly, and he could gradually stand upright and walk on the ground.
Basic information】Male, 56 years old
Disease Type】Salmonella typhimurium infection
Hospital】Huashan Hospital of Fudan University
Date of Consultation】December 2021
Treatment plan】Medication (imipenem cistatin sodium for injection, levofloxacin hydrochloride injection, levofloxacin tablets, compound sulfamethoxazole tablets) + replacement of artificial hip joint + wound debridement and dressing change
[Treatment period] The whole course of anti-infection and replacement of artificial hip joint was more than 4 months.
Treatment effect】Wound completely healed, no purulent secretion, pain improved significantly, could gradually stand upright and walk on the ground
I. Initial consultation
The patient came to our hospital in December 2021 and reported that she had an artificial hip joint replacement in a hospital in Fuzhou one year ago. The blood count was elevated to 12.8×10^9/L, CRP and other inflammatory indicators were elevated. He was treated at the local hospital, and the effect was not good. He returned to the surgical hospital for anti-infection treatment with vancomycin hydrochloride and moxifloxacin hydrochloride sodium chloride injection, etc. Subsequently, the body temperature basically decreased to normal, and the blood count decreased to 9.6×10^9/L. However, the wound still did not heal, there was purulent discharge, and the local pain was still severe. The MRI of the hip joint showed local skin soft tissue infection and sinus tract formation, but no osteomyelitis manifestation. Later, the patient went to a hospital in Wenzhou for inpatient treatment, and Salmonella typhimurium was cultured in the wound secretion during the hospitalization, so he came to our hospital for consultation. After the culture of Salmonella typhimurium, the patient was diagnosed with Salmonella typhimurium infection in the artificial hip arthroplasty wound, and was admitted to the hospital for further treatment.
II. Treatment process
After admission to our hospital, according to the laboratory results, we found that the Salmonella typhimurium cultured in the patient’s pus was very drug-resistant, so we treated the patient with injectable imipenem cistatin sodium + levofloxacin hydrochloride injection according to the drug sensitivity, and at the same time, we actively performed wound debridement and daily dressing changes. After 2 months of treatment, the orthopedic department of our hospital was contacted to remove the last artificial hip joint and replace it with a new artificial hip joint. After the operation, the patient was still treated with imipenem cistatin sodium for injection + levofloxacin hydrochloride injection for 1 month, and was discharged with wound healing and no purulent discharge. The above drugs were changed to levofloxacin tablets + compound sulfamethoxazole tablets for another 1 month of treatment.
III. Treatment effect
After admission, the patient was treated with injectable imipenem cistatin sodium + levofloxacin hydrochloride injection, while the wound was debrided and changed, and the pus discharge from the wound was reduced and the pain symptoms were relieved. After 2 months of treatment, the artificial hip joint was replaced and postoperative medication was administered for 2 months. The wound was completely healed, there was no purulent discharge, the pain was significantly improved, and the patient could go down to stand upright and walk about 10 meters. The patient and her family were satisfied with the treatment effect.
IV. Notes
We are glad that the patient’s pain was relieved, the wound healed and her body gradually recovered after medication and replacement of the artificial hip joint. Since the patient was infected with Salmonella typhimurium in the wound after surgery and the course of treatment was long, it was necessary to review liver and kidney function twice a week to prevent side effects from long-term use of antibacterial drugs. Since it is a local wound infection, attention should be paid to disinfection and wound debridement and local drug changes while using antibacterial drugs in order to speed up wound healing. A diet of light, nutritious foods, such as egg custard and milk, is recommended. In addition, active rehabilitation training is recommended to promote wound recovery and limb function recovery.
V. Personal insight
In this case, the postoperative wound was infected with the rare Salmonella typhimurium, and it was resistant to the commonly used antibiotics, so we chose to treat with imipenem cistatin sodium for injection + levofloxacin hydrochloride injection, and the course of treatment was very long, but fortunately, the final outcome was acceptable. Through the process of disease diagnosis and treatment of this patient, some experience has been accumulated for clinical anti-infection treatment.