Pseudomonas aeruginosa osteomyelitis of both ischia: a case report

Hemipelvic osteomyelitis in a hemodialysis patient associated with methicillin-resistant Staphylococcus aureus bacteremia

Proper management of infected tunneled-cuffed catheters (TCC) is essential in order to avoid catastrophic consequences for the patient. Hematogenous dissemination of infection can result in serious secondary infections, including infective endocarditis, osteomyelitis, and epidural abscess. Pelvic osteomyelitis is an extremely rare condition in adults with no reported cases of infection localized to more than one pelvic bone at a time. We present a case of a hemodialysis patient who developed osteomyelitis of the entire right hemipelvis due to MRSA bacteremia after repeated attempts at TCC salvage.

[Acute hematogenous osteomyelitis of the obturator rim in seven children]

PURPOSE OF THE STUDY

Acute osteomyelitis of the rim of the obturator foramen is rarely reported. The clinical presentation is atypical, making diagnosis a difficult task. We report a series of seven cases of osteomyelitis of the obturator rim which illustrate the different features of this localization.

MATERIAL AND METHODS

The series included seven boys with osteomyelitis involving the obturator foramen. We reviewed the clinical history, the diagnostic approach and management. Complications and anatomic outcome were noted at mean three years follow-up (range one to 10 years).

RESULTS

Mean age was 9.5 years (five to 12 years). Bilateral involvement was noted in one boy. Mean time from symptom onset to consultation was five days and mean time from consultation to hospitalization was eight days. No specific clinical presentation could be identified. Fever was not a constant feature. Mean body temperature was 38.6 degrees C and was not greater than 38.5 degrees C in four children. Symptoms were limited to hip pain in five cases and abdominopelvic pain was noted in two. Physical examination failed to trigger exquisite ischial or pubic pain in two patients. The osteomyelitis involved the ischiopubic ramus in four cases, the ischium in two with one bilateral case, and the pubis in one. Certain diagnosis was established as follows: MRI findings plus isolation of the pathogenic agent (n=4) ; the plain x-ray showed a defect in the ischiopubic ramus, MRI showed signs favoring osteomyelitis of the ischiopubic ramus and surgery evacuated a purulent collection (n=1) ; strong uptake of the obturator rim on scintigraphy (n=2). Medical treatment was given in all cases and surgery was performed in six patients. Outcome was noted at three years follow-up, range one to 10 years. All patients recovered normal function. There were no complications.

DISCUSSION

Hematogenous osteomyelitis of the pelvis is exceptional (2-11 % of cases of osteomyelitis). Localization in the obturator rim is rare. We discuss the specific diagnostic and therapeutic features of this localization. Despite the controversy concerning the treatment of pelvic osteomyelitis and in particular cases involving the obturator rim, prognosis is generally good. No complications have been described in the literature specifically associated with osteomyelitis of the obturator rim.

[Bacteriological aspects of osteitis in a university hospital]

INTRODUCTION

The aim, of our retrospective study, was to determine the epidemiological and susceptibility profile of bacterial osteitis isolates in the Rabat Mohammed V Military Hospital, to optimize the probabilistic antibiotherapy.

MATERIALS AND METHODS

A study was made from August 2004 to December 2005. All the positive specimen for the etiologic diagnosis of osteitis and osteoarthritis were included.

RESULTS

During this period, 85 osteitis cases were documented. 123 isolates were collected. 31 cases of osteitis allowed for the isolation of at least 2 bacteria (36.5%). The Gram positive cocci rate was 54.5%, the Gram negative bacilli rate 39.8%, and the Gram positive bacilli rate 5.7%. The distribution by groups was staphylococcus spp 46.4%, enterobacteriaceae 25.2% and non-fermenting Gram negative bacilli 12.9%. The most frequently isolated species were Staphylococcus aureus (23,6%) followed by Pseudomonas aeruginosa (8.9%), and Klebsiella pneumoniae (5.7%). All the S. aureus isolates were susceptible to oxacillin and 30.8% of the coagulase negative staphylococci were resistant. The enterobacteriaceae resistance rates were 64.5% for clavulanic acid-amoxicillin and 16% for third generation cephalosporin and ciprofloxacin. The non-fermenting Gram negative bacilli resistance rate was 37.5% for ceftazidim, 62.5% for ticarcillin, and 12.5% for imipenem.

CONCLUSION

Our results show the potential efficient therapy for community osteitis, using the traditional association: methicillin-aminosides and oral relay with fluoroquinolones. In nosocomial osteitis, the antibiotherapy must be modulated according to the identification and an antibiogram.