Prosthetic joint infection after total hip arthroplasty caused by Lactobacillus paracasei

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Figure 1:
Computed tomography scan of the pelvis showing a complex fluid collection around the right prosthetic hip (red arrow) in an 82-year-old woman who was subsequently diagnosed with a prosthetic joint infection after right total hip arthroplasty caused by Lactobacillus paracasei. The fluid collection extended inferiorly along the femoral shaft and superiorly along the iliopsoas muscle.

Box 1: Indications for, and associated antibiotic management of, the most common surgical options for treatment of prosthetic joint infections4

Surgery	Indications	Associated antibiotic management
Débridement, antibiotics and implant retention	Infection within 30 days from implantation Duration of symptoms < 3 weeks Well-fixed prosthesis with no sinus tract Microbiologic etiology identified preoperatively and susceptible to highly bioavailable oral antibiotics	Up to 6 weeks of intravenous antibiotics, followed by 6 weeks of highly bioavailable oral antibiotics (extended to 12 weeks for infections of knee arthroplasties)
1-stage revision arthroplasty	Total hip arthroplasty No important comorbidities Healthy reserve of bone and soft tissue No sinus tract Microbiologic etiology identified preoperatively and susceptible to highly bioavailable oral antibiotics	Up to 6 weeks of intravenous antibiotics, followed by 6 weeks of highly bioavailable oral antibiotics (extended to 12 weeks for infections of knee arthroplasties)
2-stage revision arthroplasty	Difficult-to-treat microorganisms (e.g., MRSA, Candida, highly resistant organisms) Poor soft tissue but adequate bone stock Presence of sinus tract is not a contraindication No previous 2-stage revision arthroplasty for infection Patient able to undergo 2 separate surgeries Anticipated good functional outcome	4–6 weeks of intravenous or highly bioavailable oral antibiotics after first stage