Simultaneous Bilateral Methicillin-Resistant Staphylococcus aureus Infection After Total Knee Arthroplasty Successfully Treated with Continuous Local Antibiotic Perfusion: A Case Report

BACKGROUND Continuous local antibiotic perfusion (CLAP) delivers gentamicin continuously via a bone marrow needle and double-lumen tube in the infected area, taking advantage of the concentration-dependent bactericidal activity of gentamicin, and allowing even resistant bacteria to be inhibited at high local concentrations. CLAP has shown good outcomes in bone and soft-tissue infections. However, reports on its use for periprosthetic joint infection (PJI) after total knee arthroplasty are limited. Moreover, bilateral simultaneous methicillin-resistant Staphylococcus aureus (MRSA) infection following total knee arthroplasty is rare. We report the successful CLAP treatment of simultaneous bilateral MRSA infection after total knee arthroplasty. CASE REPORT A 69-year-old man with cerebral palsy presented with a 2-week history of gait difficulty and 3-day history of fever. At 12 and 9 months before presentation, he underwent left and right total knee arthroplasty, respectively. Both knees showed swelling, pain, and redness. The leukocyte count was 12 820/μL, and C-reactive protein level was 16.27 mg/dL. Bilateral aspiration revealed gram-positive cocci, confirming PJI, without implant loosening. We performed simultaneous debridement, irrigation, insert exchange, and CLAP on both knees. Intraoperative joint fluid cultures showed MRSA. Gentamicin was given intra-articularly for 14 days alongside intravenous vancomycin, which was continued for 31 days before switching to oral minocycline for 6 months. One year after surgery, the white blood cell count was 3400/µL, the C-reactive protein level was 0.08 mg/dL, and the range of motion was 0 to 130 degrees, with no recurrence of PJI. CONCLUSIONS CLAP represents a viable treatment option for PJI caused by MRSA after total knee arthroplasty.