Management of a Complex Osteoarticular Infection Caused by Staphylococcus Aureus in an Elderly Patient

M. Lalanza1 , F. Ruiz1 , E. Oruetxebarria 1, I. Mur 2, L. Soldevila2, R.Cliville3, A. Murgadella4, C. Alborch5, A. Coloma2, L. Font-Vizcarra1

1 Trauma and Orthopaedic Department, 2 Infection Disease - Internal Medicine Department,3 Microbiology Department - Clilab Diagnòstics, 4 Department of Hospital Pharmacy, 5 Department of Pathology 

Objective:

To describe the clinical course and multidisciplinary management of a complex osteoarticular infection caused by oxacillin- susceptible Staphylococcus aureus and the therapeutic decision-making regarding definitive reconstructive surgery in an elderly patient.

Methods:

Patient 82 years, - Ischemic heart disease - Sjögren Syndrome - Chronic HCV infection - Hypothyroidism - Left TKA 2023 - Chronic lower-limb
ulcers

History of left shoulder injection 

February 2025: Left native shoulder septic arthritis due to oxacillin-sensitive S. aureus. Arthroscopic debridement Early recurrency with bacteriemia Open approach and debridement Shoulder debridement with placement of a  humeral spacer.  Simultaneous debridement of septic arthritis of the right knee Daptomycin + Ceftaroline , Dalbavancin

Progressive  clinical deterioration of the right knee Confirmation of S. aureus infection CT scan: lytic lesions compatible with osteomyelitis. Surgical debridement  and placement of a cemented spacer. Targeted intravenous antibiotic therapy FINAL ANTIBIOTIC TREATMENT: CEFAZOLIN + DALBAVANCIN

Results

• Overall favorable postoperative course from an infectious standpoint

 • Local complications with wound-healing problems at the surgical wound of the knee, requiring advanced dressing and negative-

pressure wound therapy

• Functional rehabilitation maintained: 

oKnee range of motion: 0-90o 

oStable spacer oAmbulation with a walker

 

• Radiologic follow-up: no signs of spacer loosening or migration

• Given the patient’s advanced age, comorbidities, and local wound-  healing complications, the second-stage reconstruction was ruled out, opting instead to maintain the spacer and continue conservative treatment.

Conclusion

Staphylococcus aureus bacteremia in elderly patients represents a highly serious clinical condition associated with high morbidity and mortality and a high risk  of hematogenous dissemination with multifocal osteoarticular involvement, as illustrated by this case.