抄録
A case of methicillin-resistant Staphylococcus aureus (MRSA) pyogenic arthritis and sepsis after total knee arthroplasty is reported in a patient with rheumatoid arthritis. Treatment using linezolid was successful without removing the artificial joint. A 70-year-old woman who was under treatment for rheumatoid arthritis underwent total knee arthroplasty for right gonarthrosis. Seven days after surgery, she developed delirium, knelt on the floor, and then hit the knee, causing a hematoma. Seven days later, she developed fever, and a large amount of pus was drained from the right knee wound. MRSA was detected by culture. Sensitivity testing showed good sensitivity for arbekacin and vancomycin. Arbekacin was administered, and the joint was incised in order to wash it out, followed by continuous perfusion. Arbekacin was added to the perfusion fluid, and vancomycin was intravenously infused. Since the implant was well fixed to bone, it was not removed. However, the fever did not improve, and MRSA was detected in the perfusion fluid, blood, and the operative wound in the patellar tendon by culture. After eight days of perfusion, intravenous infusion of linezolid was initiated at 600 mg twice a day, and vancomycin was added to the perfusion fluid. The day after initiation of infusion of linezolid, the fever had resolved, C-reactive protein levels had decreased, and blood bacterial culture was negative. Linezolid was discontinued 18 days after the start of administration because the white blood cell count had decreased, and the knee wound was closed. No sign of relapse of infection developed after discharge.Linezolid has good tissue transfer and is considered to transfer to bone and joints at a high rate. It was used to successfully treat a prosthetic joint infection with sepsis.
