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Volume 7, Issue 9

A novel case of prosthetic joint infection due to successfully suppressed with oral doxycycline Open Access

Abstract

Extra-colonic infections caused by are exceptionally rare, with prosthetic joint infections (PJIs) comprising only a small fraction of the reported cases. Moreover, there is limited guidance on the optimal management of such infections. We present the case of a 76-year-old man who developed a left hip PJI due to 6 weeks after undergoing surgical revision for a periprosthetic fracture. Given the complexity of the case, curative surgical intervention was not considered feasible. The patient was treated with repeated debridement, intravenous vancomycin and oral (PO) metronidazole, followed by successful suppression with PO doxycycline – a novel therapeutic approach not previously documented. To date, only seven cases of -associated PJI have been reported in the literature; this is the first known instance in which suppression of a PJI has been achieved and the first to utilize whole-genome sequencing for further analysis of the isolate.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): antibiotic stewardship , Clostridium difficile , prosthetic joint infection and whole-genome sequencing
© 2025 Crown copyright
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License.
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2025-09-19
2026-04-14

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References

  1. Cepheid Xpert® C.difficile/Epi. 300-9680; 2020Apr https://web-support.cepheid.com/Package%20Insert%20Files/Xpert%20C.%20diff-Epi/300-9680-Xpert-C.%20diff-Epi%20US-IVD%20PI%20Rev%20J.pdf
  2. McCarthy J, Stingemore N. Clostridium difficile infection of a prosthetic joint presenting 12 months after antibiotic-associated diarrhoea. J Infect 1999; 39:94–96 [View Article] [PubMed]
     [Google Scholar]
  3. Pron B, Merckx J, Touzet P, Ferroni A, Poyart C et al. Chronic septic arthritis and osteomyelitis in a prosthetic knee joint due to Clostridium difficile. Eur J Clin Microbiol Infect Dis 1995; 14:599–601 [View Article] [PubMed]
     [Google Scholar]
  4. Achong DM, Oates E. Periprosthetic Clostridium difficile hip abscess imaged with In-111 WBCs. Clin Nucl Med 1994; 19:860–862 [View Article] [PubMed]
     [Google Scholar]
  5. Song Y, Shao HY, Cheng X, Guo Y. First case of periprosthetic joint infection due to Clostridioides difficile in China. BMC Infect Dis 2021; 21:462 [View Article] [PubMed]
     [Google Scholar]
  6. Ranganath S, Midturi JK. Unusual case of prosthetic shoulder joint infection due to Clostridium difficile. Am J Med Sci 2013; 346:422–423 [View Article] [PubMed]
     [Google Scholar]
  7. Brassinne L, Rodriguez-Villalobos H, Jonckheere S, Dubuc JE, Yombi JC. Early infection of hip joint prosthesis by Clostridium difficile in an HIV-1 infected patient. Anaerobe 2014; 27:96–99 [View Article] [PubMed]
     [Google Scholar]
  8. Curtis L, Lipp MJ. Clostridium difficile infection of a prosthetic knee joint requiring amputation. Surg Infect 2013; 14:163–164 [View Article] [PubMed]
     [Google Scholar]
  9. Czepiel J, Dróżdż M, Pituch H, Kuijper EJ, Perucki W et al. Clostridium difficile infection: review. Eur J Clin Microbiol Infect Dis 2019; 38:1211–1221 [View Article] [PubMed]
     [Google Scholar]
  10. Vaishnavi C. Clinical spectrum & pathogenesis of Clostridium difficile associated diseases. Indian J Med Res 2010; 131:487–499 [PubMed]
     [Google Scholar]
  11. Libby DB, Bearman G. Bacteremia due to Clostridium difficile--review of the literature. Int J Infect Dis 2009; 13:e305–9 [View Article] [PubMed]
     [Google Scholar]
  12. Awad MM, Johanesen PA, Carter GP, Rose E, Lyras D. Clostridium difficile virulence factors: insights into an anaerobic spore-forming pathogen. Gut Microbes 2014; 5:579–593 [View Article] [PubMed]
     [Google Scholar]
  13. Gerding DN, Johnson S, Rupnik M, Aktories K. Clostridium difficile binary toxin CDT: mechanism, epidemiology, and potential clinical importance. Gut Microbes 2014; 5:15–27 [View Article] [PubMed]
     [Google Scholar]
  14. Baban ST, Kuehne SA, Barketi-Klai A, Cartman ST, Kelly ML et al. The role of flagella in Clostridium difficile pathogenesis: comparison between a non-epidemic and an epidemic strain. PLoS One 2013; 8:e73026 [View Article] [PubMed]
     [Google Scholar]
  15. Dawson LF, Peltier J, Hall CL, Harrison MA, Derakhshan M et al. Extracellular DNA, cell surface proteins and c-di-GMP promote biofilm formation in Clostridioides difficile. Sci Rep 2021; 11:3244 [View Article] [PubMed]
     [Google Scholar]
  16. Penesyan A, Nagy SS, Kjelleberg S, Gillings MR, Paulsen IT. Rapid microevolution of biofilm cells in response to antibiotics. NPJ Biofilms Microbiomes 2019; 5:34 [View Article] [PubMed]
     [Google Scholar]
  17. Sisson G, Jeong JY, Goodwin A, Bryden L, Rossler N et al. Metronidazole activation is mutagenic and causes DNA fragmentation in Helicobacter pylori and in Escherichia coli containing a cloned H. pylori RdxA(+) (Nitroreductase) gene. J Bacteriol 2000; 182:5091–5096 [View Article] [PubMed]
     [Google Scholar]
  18. Taggart MG, Snelling WJ, Naughton PJ, La Ragione RM, Dooley JSG et al. Biofilm regulation in Clostridioides difficile: Novel systems linked to hypervirulence. PLoS Pathog 2021; 17:e1009817 [View Article] [PubMed]
     [Google Scholar]
  19. Knight DR, Imwattana K, Collins DA, Lim S-C, Hong S et al. Genomic epidemiology and transmission dynamics of recurrent Clostridioides difficile infection in Western Australia. Eur J Clin Microbiol Infect Dis 2023; 42:607–619 [View Article] [PubMed]
     [Google Scholar]
  20. Putsathit P, Hong S, George N, Hemphill C, Huntington PG et al. Antimicrobial resistance surveillance of Clostridioides difficile in Australia, 2015-18. J Antimicrob Chemother 2021; 76:1815–1821 [View Article] [PubMed]
     [Google Scholar]
  21. Imwattana K, Rodríguez C, Riley TV, Knight DR. A species-wide genetic atlas of antimicrobial resistance in Clostridioides difficile. Microb Genom 2021; 7:000696 [View Article] [PubMed]
     [Google Scholar]
  22. Malahias M-A, Gu A, Harris EC, Adriani M, Miller AO et al. The role of long-term antibiotic suppression in the management of peri-prosthetic joint infections treated with debridement, antibiotics, and implant retention: a systematic review. J Arthroplasty 2020; 35:1154–1160 [View Article] [PubMed]
     [Google Scholar]
  23. Rao N, Crossett LS, Sinha RK, Le Frock JL. Long-term suppression of infection in total joint arthroplasty. Clin Orthop Relat Res 200355–60 [View Article] [PubMed]
     [Google Scholar]
  24. Daneman N, Cheng Y, Gomes T, Guan J, Mamdani MM et al. Metronidazole-associated neurologic events: a nested case-control study. Clin Infect Dis 2021; 72:2095–2100 [View Article]
     [Google Scholar]
  25. Sears P, Crook DW, Louie TJ, Miller MA, Weiss K. Fidaxomicin attains high fecal concentrations with minimal plasma concentrations following oral administration in patients with Clostridium difficile infection. Clin Infect Dis 2012; 55 Suppl 2:S116–20 [View Article] [PubMed]
     [Google Scholar]
  26. Agwuh KN, MacGowan A. Pharmacokinetics and pharmacodynamics of the tetracyclines including glycylcyclines. J Antimicrob Chemother 2006; 58:256–265 [View Article] [PubMed]
     [Google Scholar]
  27. Brown KA, Khanafer N, Daneman N, Fisman DN. Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection. Antimicrob Agents Chemother 2013; 57:2326–2332 [View Article] [PubMed]
     [Google Scholar]
/content/journal/acmi/10.1099/acmi.0.000943.v3
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A novel case of prosthetic joint infection due to Clostridioides difficile successfully suppressed with oral doxycycline
Access Microbiology 7, 000943.v3 (2025); https://doi.org/10.1099/acmi.0.000943.v3
/content/journal/acmi/10.1099/acmi.0.000943.v3
/content/journal/acmi/10.1099/acmi.0.000943.v3
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