Clostridial Prosthetic Joint Infections: A Review of the Literature, Management Strategies, and Outcomes.

Clostridial prosthetic joint infections (PJIs) are rare causes of anaerobic implant infections, with limited published data to guide diagnosis or management. Most reported cases involve Clostridium perfringens or C. difficile, although other Clostridium species can also be implicated. Owing to their rarity and diverse clinical behaviour, the optimal management of clostridial PJIs remains uncertain. All published cases of clostridial PJIs were identified through a literature review up to September 2025. Cases were included if the prosthetic joint infection was clearly attributed to a Clostridium species and excluded if data were insufficient. Data was extracted on patient demographics, microbiology, management, and outcomes. Thirty-four cases were included: C. perfringens (n = 16), C. difficile (n = 11), and other Clostridium species (n = 7). The majority of patients were older adults with significant comorbidity or immune suppression. C. perfringens infections were predominantly early-onset, often associated with gas formation and favourable outcomes after surgical intervention and penicillin-based therapy. C. difficile PJIs were usually monomicrobial, often treated with metronidazole, while other Clostridium species presented as late-onset infections, frequently in association with malignancy or immunosuppression. Antimicrobial therapy varied between cases, reflecting the absence of standardised regimens and the need for individualised treatment approaches. Across all reported cases, the majority achieved infection control following combined surgical and antimicrobial therapy. This review consolidates all available data on clostridial PJIs to date, defines their microbiological and clinical spectrum, and provides practical insight into the diagnosis and management of these uncommon infections while highlighting the need for greater awareness and standardised treatment strategies.