Nontyphoid salmonellosis in patients with total hip replacement: report of four cases and review of the literature.

Five episodes of nontyphoid salmonella infection following total hip replacement in four patients were studied. In three patients the infection occurred in the immediate postoperative period while prophylactic antibiotics were being administered. The fourth patient had bilateral total hip replacements five years apart with two nontyphoid salmonella infections, one immediately after the first operation (during antibiotic prophylaxis) and the second four years after the second operation. In addition to local infection, clinical manifestations included fever (all patients), diarrhea (three patients), deep prosthetic infection (two patients), and shock with disseminated intravascular coagulation and acute renal failure (one patient). In addition to antibiotic therapy, removal of the prosthesis was necessary for cure in three patients. All patients recovered. Hematogenous spread was thought likely in all cases. Four of five salmonella isolates were resistant to ampicillin and chloramphenicol. A review of the English-language literature yielded information on five additional cases of nontyhpoid salmonella infection after total hip replacement in four patients.