“A Difficile-cult Case” – Clostridioides difficile prosthetic joint infection; case report, microbiology, and review of the literature.

Extra-colonic infections caused by Clostridioides difficile (C. difficile) are exceptionally rare, with prosthetic joint infections (PJI) comprising only a small fraction of reported cases. Moreover, there is limited guidance on the optimal management of such infections. We present the case of a 76-year-old male who developed a left hip PJI due to C. difficile six 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 metronidazole, followed by successful suppression with oral doxycycline – a novel therapeutic approach not previously documented. To date, only seven cases of C. difficile-associated PJI have been reported in the literature; this is the first known instance where suppression of a C. difficile PJI has been achieved and the first to utilize whole genome sequencing for further analysis of the isolate.