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Ryskova L, Zahradnicek J, Kukla R, Bolehovska R, Vajda M, Pavlik I, Bostik P, Ryska P. Dual Infection of an Open Fracture Caused by Mycobacterium setense and Clostridium celerecrescens. Antibiotics (Basel) 2022; 11:antibiotics11091254. [PMID: 36140033 PMCID: PMC9495126 DOI: 10.3390/antibiotics11091254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/05/2022] [Accepted: 09/14/2022] [Indexed: 12/04/2022] Open
Abstract
Infections caused by Mycobacterium setense or Clostridium celerecrescens are extremely rare. In this report, for the first time a dual infection with these two pathogens is described. An 18-year-old female suffered multiple injuries, including an open comminuted fracture of the right humeral diaphysis after falling from a fifth-floor balcony in January 2019. Five months after the accident, a fistula appeared in the scar, reaching the bone tissue. M. setense and C. celerecrescens were cultured from sinus swabs and subsequently from perioperative samples. The patient was initially treated with a combination of intravenous antibiotics (ATBs): imipenem, amikacin, and ciprofloxacin. One month after the fracture fixation with a titanium nail, C. celerecrescens was again detected; therefore, metronidazole was added to the therapy. A triple combination of oral (PO) ATBs (trimethoprim–sulfamethoxazole, moxifloxacin, and metronidazole) followed, 8 weeks after the initial intravenous therapy. C. celerecrescens was cultured again two times, most recently in November 2019, when surgical debridement was supplemented by the topical administration of cancellous bone impregnated with vancomycin. Signs of bone healing were found at follow-ups and ATB treatment was finished in March 2020 after a total of 9 months of therapy. To this day, there have been no signs of reinfection. This case thus illustrates the need for a combination of systemic and individualized local therapy in the treatment of complicated cases of dual infections with rare pathogens.
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Affiliation(s)
- Lenka Ryskova
- Institute of Clinical Microbiology, Faculty of Medicine in Hradec Kralove, Charles University and University Hospital, 50005 Hradec Kralove, Czech Republic
| | - Jan Zahradnicek
- Department of Surgery, Faculty of Medicine in Hradec Kralove, Charles University and University Hospital, 50005 Hradec Kralove, Czech Republic
| | - Rudolf Kukla
- Institute of Clinical Microbiology, Faculty of Medicine in Hradec Kralove, Charles University and University Hospital, 50005 Hradec Kralove, Czech Republic
| | - Radka Bolehovska
- Institute of Clinical Microbiology, Faculty of Medicine in Hradec Kralove, Charles University and University Hospital, 50005 Hradec Kralove, Czech Republic
| | - Milan Vajda
- Department of Diagnostic Radiology, Faculty of Medicine in Hradec Kralove, Charles University and University Hospital, 50005 Hradec Kralove, Czech Republic
| | - Ivo Pavlik
- Faculty of Regional Development and International Studies, Mendel University in Brno, tr. Generala Piky 7, 61300 Brno, Czech Republic
| | - Pavel Bostik
- Institute of Clinical Microbiology, Faculty of Medicine in Hradec Kralove, Charles University and University Hospital, 50005 Hradec Kralove, Czech Republic
- Correspondence:
| | - Pavel Ryska
- Department of Diagnostic Radiology, Faculty of Medicine in Hradec Kralove, Charles University and University Hospital, 50005 Hradec Kralove, Czech Republic
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Corrigan RA, Lomas-Cabeza J, Stubbs D, McNally M. Clostridium cadaveris Osteomyelitis: an Unusual Pathogen which Highlights the Importance of Deep Tissue Sampling in Chronic Osteomyelitis. J Bone Jt Infect 2020; 5:96-100. [PMID: 32455100 PMCID: PMC7242405 DOI: 10.7150/jbji.43801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/23/2020] [Indexed: 11/07/2022] Open
Abstract
Clostridium cadaveris, named following its identification in human corpses, is an unusual pathogen. We report the first case of C. cadaveris osteomyelitis. This case highlights the importance of deep tissue sampling and appropriate culture to correctly identify causative pathogens and guide targeted antimicrobial therapy in difficult-to-treat infections like chronic osteomyelitis.
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Affiliation(s)
- Ruth Alexandra Corrigan
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Oxford, OX3 7HE, UK.,Nuffield Department of Clinical Laboratory Sciences, Radcliffe Department of Medicine, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Jose Lomas-Cabeza
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Oxford, OX3 7HE, UK
| | - David Stubbs
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Oxford, OX3 7HE, UK
| | - Martin McNally
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Road, Oxford, OX3 7HE, UK
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