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This case report describes a periprosthetic hip infection (PJI) in a female patient initially infected with *Fusobacterium nucleatum*, followed by *Acinetobacter baumannii*. The patient underwent unsuccessful DAIR, followed by staged revision arthroplasty with a cement spacer, prolonged antibiotics including cefiderocol, ultimately achieving infection eradication and a good functional outcome.
This case highlights the potential for PJI to involve rare anaerobic bacteria and multidrug-resistant Gram-negative pathogens, necessitating tailored surgical and antimicrobial strategies.
Periprosthetic joint infection (PJI) is a serious complication following total hip arthroplasty and is most commonly caused by Gram-positive organisms. Infections involving anaerobic bacteria or multidrug-resistant Gram-negative pathogens are rare and particularly challenging to manage. We report a case of periprosthetic hip infection in a female patient in whom Fusobacterium nucleatum (F. nucleatum) was initially isolated, followed by Acinetobacter baumannii (A. baumannii) later in the treatment course. Initial management with debridement, antibiotics, and implant retention (DAIR) was unsuccessful, necessitating implant removal, placement, and subsequent removal of a cement spacer, as well as prolonged targeted antimicrobial therapy, including cefiderocol. Following staged revision arthroplasty, successful infection eradication was achieved with an excellent functional outcome. This report highlights the complexity of PJI management, the potential for microbiologic evolution under antimicrobial pressure, and the importance of tailored surgical and antimicrobial strategies.
