Pseudomonas Aeruginosa Joint and Graft Infection following Anterior Cruciate Ligament Reconstruction Surgery

Abstract

Case report Introduction Surgical site infection (SSI) is a rare postoperative complication of anterior cruciate ligament (ACL) reconstruction that can be devastating if not urgently treated. Uncommonly cultured from SSI's is Pseudomonas aeruginosa. While many nosocomial etiologies have been reported in the literature, no environmental etiologies have been reported. In this case report, we describe a patient presenting with a post-operative P. aeruginosa infection likely secondary to environmental hot tub exposure. Case description A 15-year-old male presented to our clinic with a right ACL tear sustained after a football injury. Eight weeks after surgery, the patient returned with a painful red bump over the tibial incision site. The abscess and joint fluid were aspirated and grew P. aeruginosa in culture. Upon further questioning, the patient reported swimming in a recreational hot tub about 2 weeks after initial surgery. Incision and drainage revealed significant synovitis and a grossly infected graft. The graft and associated hardware were subsequently removed. He was initially treated with two days of IV cefepime and transitioned to oral levofloxacin based on culture susceptibilities. After CRP normalisation, he went on to complete a three month course of oral levofloxacin and subsequently make progress in physical therapy. Discussion Given that P. aeruginosa is commonly found in moist environments, the patient's history of hot tub use was the most likely aetiology of SSI. To our knowledge, this is the first reported case of P. aeruginosa infection following ACL reconstruction attributed to a presumed environmental cause. Even though infection after ACL reconstruction is rare, providers can take measures to prevent this type of infection for future patients. Clinicians should remain cognizant that public pools, hot tubs, and other moist environments pose a P. aeruginosa infection risk to surgical incision sites. We suggest that patients be informed of this risk to avoid a potentially serious postoperative complication.