Salmonella Infection at the Surgical Site after Spinal Fusion at a Foreign Hospital—A Case Report

An 84-year-old man suffered severe low-back pain after falling on a cruise ship. He got ashore in Chile and was admitted to a local hospital 7 days after injury. His diagnosis was L3 vertebral burst fracture. Bone fragment extruded in to the spinal canal about 50%. Posterior spinal fixation surgery was performed 4 days after admission, when he found it difficult to walk due to severe low-back pain. He had an episode of high fever 8 days after surgery, and antibiotic therapy was initiated using ciprofloxacin. Magnetic resonance image (MRI) revealed iliopsoas muscle empyema and pyogenic spondylitis. A drainage tube was inserted into the empyema cavity 17 days after surgery. Salmonella was detected in the culture specimen of the iliopsoas muscle empyema. He departed from Chile 20 days after the surgery and, 5 days later, he was admitted to our hospital via a hospital in Mexico. On admission to our hospital, his operative wound was dehisced and his abdominal computed tomography (CT) images revealed increased abscess on both sides of iliopsoas muscles. Removal of the instrument and debridement was performed on the third day at our hospital. Salmonella enteritidis growth was detected in a specimen of the wound. Drip infusion of ciprofloxacin was continued until the 42nd day in our hospital. Ceftriaxone and minocycline were administrated from the 42nd day to the 91st day. The exact route of salmonella infection was not determined because he had no abdominal symptoms such as diarrhea during the entire course and salmonella was not cultured from fecal specimen. Two possible routes of infection were considered. The first was infection through the blood stream. A Salmonella colony may have caused bacteremia, which led to the development of pyogenic spondylitis. Second, the surgical site infection may have spread. Here, the authors reported the case of a patient who developed surgical site Salmonella enteritidis infection at a foreign hospital.