Cefadroxil-Induced Clostridium difficile Infection Following Total Knee Arthroplasty

Nathan Angerett; Christopher Ferguson; Michael Kahan; Devin Fitz; Richard Hallock

doi:10.1016/j.artd.2022.08.016

Cefadroxil-Induced Clostridium difficile Infection Following Total Knee Arthroplasty

Arthroplast Today. 2022 Oct 12:18:52-56. doi: 10.1016/j.artd.2022.08.016. eCollection 2022 Dec.

Authors

Nathan Angerett^{1

2

3}, Christopher Ferguson¹, Michael Kahan^{1

3}, Devin Fitz¹, Richard Hallock^{1

2}

Affiliations

¹ UPMC Harrisburg, Harrisburg, PA, USA.
² Orthopedic Institute of Pennsylvania, Camp Hill, PA, USA.
³ Sinai Hospital of Baltimore, Rubin Institute of Advanced Orthopedics, Baltimore, MD, USA.

Abstract

Perioperative infection prophylaxis is a fundamental element of total knee arthroplasty (TKA). There has been a recent trend toward the use of extended postoperative oral antibiotics in high-risk patients. We describe a case report of a patient who underwent a primary TKA and subsequently developed Clostridium difficile colitis after an extended course of postoperative prophylactic oral cefadroxil. Following the C. difficile infection, the patient eventually developed bacteremia and a multidrug-resistant Escherichia coli prosthetic joint infection which required multiple debridements. Extended use of postoperative prophylactic oral cefadroxil may increase the risk of C. difficile-associated diarrhea. Additionally, our case suggests that C. difficile infection may subsequently increase the risk of bacteremia which could lead to prosthetic joint infection. More evidence is required to further define this risk.

Keywords: C. difficile; Case report; Cefadroxil; Extended postoperative antibiotics; Prosthetic joint infection; Total knee arthroplasty.

Publication types

Case Reports