PDF(Pubmed)
Abstract：
This case-report focuses on a 23-year-old soldier suffering from a fracture-related hip joint infection (FRI) due to extensively drug-resistant Klebsiella pneumoniae and S. epidermidis. The patient underwent multiple septic revision surgeries including the removal of remaining shrapnel accompanied by last-resort antimicrobial therapy with cefiderocol and colistin. Additionally, the surgeries included repeated tissue sampling for microbiological and histopathological analysis. An antibiotic-loaded cemented filler containing cefiderocol was used to improve local antimicrobial therapy. The biopsies prior to and during hip replacement surgery confirmed successful microbe eradication. Hip arthroplasty restored hip joint function and significantly improved patient\'s quality of life. The utilization of a trabecular metal shell and a meta-diaphyseally anchored cementless hip stem ensured secure implant fixation and early patient mobilisation. An adjusted biofilm active oral antimicrobial therapy after arthroplasty intervention was continued to prevent early periprosthetic joint infection. This case emphasizes the difficulties of managing FRI and multidrug-resistant pathogens. It contributes valuable insight into navigating complex orthopedic cases while ensuring successful hip arthroplasty outcomes. In conclusion, early interdisciplinary collaboration, appropriate antimicrobial therapy along with tailored surgical interventions are crucial for managing such complex cases successfully.
摘要：
该病例报告的重点是一名23岁的士兵，由于广泛耐药的肺炎克雷伯菌和表皮葡萄球菌而患有骨折相关的髋关节感染（FRI）。患者接受了多次脓毒症翻修手术，包括去除剩余的弹片，并伴有头孢地洛和粘菌素的最后手段抗菌治疗。此外,手术包括重复组织取样进行微生物和组织病理学分析.含有头孢地洛的负载抗生素的胶结填料用于改善局部抗菌治疗。在髋关节置换手术之前和期间的活检证实了成功的微生物根除。髋关节置换术恢复了髋关节功能,明显改善了患者的生活质量。使用小梁金属外壳和远端固定的无骨水泥髋关节干确保了植入物的固定和早期患者的动员。关节成形术干预后继续进行调整的生物膜活性口服抗菌治疗，以预防早期假体周围关节感染。该案例强调了管理FRI和多药耐药病原体的困难。它有助于导航复杂的骨科病例，同时确保成功的髋关节置换术结果的宝贵见解。总之,早期的跨学科合作，适当的抗菌治疗以及量身定制的手术干预措施对于成功管理此类复杂病例至关重要.
