The Challenging Management of an Acinetobacter Baumannii Infection and Recurrent Subcutaneous Abscess in an Elderly Patient Undergoing Surgery for Hip Fracture

Background: Proximal femoral fractures are the most prevalent disabling traumatic injuries among the elderly, imposing significant human and societal burdens.Surgical fixation, preferably via intramedullary nailing due to its minimally invasive nature, is the standard treatment.However, postoperative complications, such as femoral shaft fractures, remain common and may necessitate reoperation.Early and intensive rehabilitation is crucial to optimize functional recovery and quality of life.While frailty is often considered an absolute contraindication to surgery, this case challenges that paradigm. Case presentation:We present the case of an 84-year-old woman admitted for a comminuted fracture of the right femur on residual osteosynthesis (gamma nail implanted in 2017 for a prior subtrochanteric fracture).Her medical history included chronic lymphocytic leukemia, permanent atrial fibrillation requiring anticoagulant therapy (Edoxaban 30 mg), chronic heart and renal failure, previous colon cancer, and a stage II sacral ulcer, indicating limited potential for functional recovery.Shortly after admission, the patient underwent revision fixation of the right femoral fracture with the placement of a diaphyseal metal plate and cerclage wire.Postoperatively, she developed acute respiratory failure requiring non-invasive ventilatory support and brief intensive care unit (ICU) monitoring.Chest computed tomography (CT) revealed a left parieto-apico-basal pneumothorax, bilateral mucus plugging of lobar bronchi, complete atelectasis of the left lower lobe, mild hypoexpansion of the left upper lobe, and a thin left sided pleural effusion.Bronchoscopy was performed for airway clearance and identified Acinetobacter baumannii in the bronchoalveolar lavage.