# Salmonella enteritidis: a rare pathogen in a polymicrobial acute prosthetic joint infection following total hip arthroplasty treated with double debridement, antibiotics, and implant retention (DAIR)

## TL;DR

A rare case of Salmonella enteritidis prosthetic joint infection was successfully treated with double debridement and antibiotics.

## Contribution

This case highlights the effectiveness of double DAIR for acute polymicrobial PJI caused by an atypical pathogen.

## Key findings

- Salmonella enteritidis was identified as part of a polymicrobial infection without a primary focus.
- Double DAIR combined with a 3-month antibiotic regimen resolved the infection and preserved the prosthesis.
- Inflammatory markers normalized, and the patient regained mobility without prosthetic loosening.

## Abstract

Prosthetic joint infection (PJI) with Salmonella enteritidis is rare following orthopedic surgery and joint arthroplasty. This is a case of a 77-year-old female with left femoral transcervical fracture underwent total hip arthroplasty. At 2-weeks follow-up, the patient developed a PJI that was treated with double debridement, antibiotics, and implant retention (DAIR). Intraoperative cultures revealed unusual S. enteritidis without a primary focus of infection as part of polymicrobial PJI. She received a 3-month course of antibiotics including per os (PO) azithromycin and intravenous (IV) ceftriaxone that was switched to IV meropenem. At last follow-up, infection had resolved, inflammatory markers normalized, there was no evidence of prosthetic loosening and the patient was ambulatory. Salmonella organism is an atypical isolate in PJI. In the absence of a primary cause and in the context of acute infection, double DAIR is a viable option to salvage the prosthesis when a dual approach of aggressive intraoperative debridement and postoperative antibiotics coverage is employed.