Bacteroides fragilis Arthritis Following Cesarean Section

• Published in: Clinical infectious diseases 1995-11, Vol.21 (5), p.1341-1342
• Main Authors: Failla, Diane M., Dalovisio, Joseph R.
• Format: Article
• Language: English
• Subjects: Adult; Anaerobic bacteria; Anti-Bacterial Agents; Arthritis; Arthritis, Infectious - diagnosis; Arthritis, Infectious - drug therapy; Arthritis, Infectious - etiology; Bacteroides; Bacteroides fragilis; Bacteroides fragilis - pathogenicity; Bacteroides Infections - diagnosis; Bacteroides Infections - drug therapy; Bacteroides Infections - etiology; Biological and medical sciences; Brief Reports; Cesarean section; Cesarean Section - adverse effects; Delivery. Postpartum. Lactation; Drug Therapy, Combination - therapeutic use; Female; Gynecology. Andrology. Obstetrics; Hip; Hip joint; Humans; Immunocompetence; Infections; Joints; Medical sciences; Obstetrical techniques; Postoperative Complications - diagnosis; Postoperative Complications - drug therapy; Postoperative Complications - etiology; Pregnancy; Rheumatoid arthritis
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/clinids/21.5.1341

We describe what we believe to be the first documented case of Bacteroides fragilis arthritis following cesarean section in an immunocompetent patient. A 21-year-old previously healthy female was delivered of a full-term healthy baby by cesarean section. She was discharged 3 days after surgery, but her temperature spiked to 101 degree F on the following day, and she was readmitted for treatment with intravenous antibiotics. Cultures were performed, and the patient was discharged with a prescription for amoxicillin/clavulanic acid. Within several days she developed severe pain in the right hip and again had a fever. The pain was not relieved with administration of acetaminophen and application of heat. She subsequently noted purulent discharge from her incision, continued to have elevated temperatures, and was readmitted to the hospital. The patient underwent surgery, and foul-smelling, purulent drainage was aspirated. Cultures of this specimen, as well as uterine cultures performed on her first readmission, yielded B. fragilis group organisms. The patient received treatment with ticarcillin/clavulanic acid for 3 weeks and was discharged with a prescription for oral metronidazole. On her last clinic visit, similar to 6 weeks after surgery, she was well, although she had some residual discomfort in the right hip. The most recent pelvic roentgenogram showed significant narrowing of the right hip joint, and her ESR and CRP levels have both normalized.