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Adams JP, Habenicht D, Ramsey D. Periprosthetic knee infection after benign tumor excision complicated by carbapenem resistant Enterobacteriaceae: A case report. Ann Med Surg (Lond) 2022; 81:104292. [PMID: 36147108 PMCID: PMC9486372 DOI: 10.1016/j.amsu.2022.104292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Periprosthetic joint infection (PJI) is a major complication after total knee arthroscopy. Enterobacter is a rare cause of PJI. Case presentation We present a 65 year old Caucasian man who presented with acute right knee PJI with Carbapenem-resistant Enterobacteriaceae (CRE) two months after undergoing right knee intra-articular mass removal with endoprosthetic reconstruction. The periprosthetic joint infection (PJI) was treated with revision with 1-stage static spacer and IV meropenem. Discussion CRE is an uncommon cause of PJI, but when it does occur, it commonly infects patients who are immunosuppressed or have specific risk factors. For an immunocompetent patient with CRE PJI, we suggest further workup for other systemic disease. Conclusion This case demonstrates the importance of early diagnosis and treatment of CRE joint infections and the need for a multidisciplinary approach that includes aggressive surgical intervention and tailored antimicrobial therapy. We present a case of acute right knee periprosthetic joint infection with Carbapenem-resistant Enterobacteriaceae (CRE) after patient underwent intra-articular mass removal with endoprosthetic reconstruction. Further workup for systemic disease is strongly recommended in immunocompetent patients presenting with CRE joint infection. Management of CRE joint infections is complicated and requires a multidisciplinary approach with aggressive surgical intervention and focused antimicrobial therapy.
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Davido B, Saleh-Mghir A, Rottman M, Jaffal K, Salomon E, Bouchand F, Lawrence C, Bauer T, Herrmann JL, De Truchis P, Noussair L, Cremieux AC. Native bone and joint infections caused by extended-spectrum β-lactamase-producing Enterobacterales: experience of a reference centre in the Greater Paris area. Int J Antimicrob Agents 2021; 59:106497. [PMID: 34906675 DOI: 10.1016/j.ijantimicag.2021.106497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/01/2021] [Accepted: 12/04/2021] [Indexed: 11/05/2022]
Abstract
Antibiotic treatment of native osteomyelitis caused by extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) is a challenge. Limited epidemiological and outcome data are available. This retrospective cohort study included osteomyelitis patients with ESBL-PE infections treated in a reference centre for bone and joint infections (BJIs) between 2011-2019. Twenty-nine patients with native BJI (mean age, 44.4 ± 15.7 years) were analysed. Fifteen cases were paraplegic patients with ischial pressure sores breaching the hip capsule. Other cases included eight other hip infections, four tibial infections and two foot infections. Infections were mostly polymicrobial (n = 23; 79.3%), including Staphylococcus aureus (n = 13; 8 methicillin-resistant). Klebsiella pneumoniae (n = 13) was the most frequent ESBL-producing species identified, followed by Escherichia coli (n = 10), including 3 E. coli/K. pneumoniae co-infections, and Enterobacter spp. (n = 9). ESBL-PE were rarely susceptible to fluoroquinolones (n = 4; 13.8%). Most therapies were based on carbapenems (n = 22) and combination therapies (n = 19). The median duration of treatment was 41 (5-60) days. Primary control of the infection was achieved in 62.1% (18/29) of cases and up to 86.2% after second look surgeries, after a median follow-up of 6 (1-36) months. Infection with ESBL-producing K. pneumoniae was associated with failure (P = 0.001), whereas age, infection location, prior colonisation and antimicrobial therapy were not found to be predictors of outcome. ESBL-PE native BJIs are often polymicrobial and fluoroquinolone-resistant infections caused by K. pneumoniae, highlighting the need for expert centres with pluridisciplinary meetings with experienced surgeons.
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Affiliation(s)
- B Davido
- Service des Maladies Infectieuses, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France.
| | - A Saleh-Mghir
- Service des Maladies Infectieuses, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France
| | - M Rottman
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France
| | - K Jaffal
- Service des Maladies Infectieuses, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - E Salomon
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - F Bouchand
- Pharmacie Hospitalière, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - C Lawrence
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - T Bauer
- Service d'Orthopédie, Université Paris-Saclay, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - J L Herrmann
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France
| | - P De Truchis
- Service des Maladies Infectieuses, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - L Noussair
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - A C Cremieux
- Service de Maladies Infectieuses, Université Paris Nord, Hôpital Saint-Louis, AP-HP, Paris, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France
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Rempenault C, Pagis V, Noussair L, Berbescu S, Duran C, Bouchand F, de Laroche M, Salomon E, Nich C, Bauer T, Rottman M, Davido B, Matt M, Dinh A. Treatment of bone and joint infections by ceftazidime/avibactam and ceftolozane/tazobactam: a cohort study. J Glob Antimicrob Resist 2021; 25:282-286. [PMID: 33933698 DOI: 10.1016/j.jgar.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 11/20/2020] [Accepted: 04/19/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Ceftazidime/avibactam (C/A) and ceftolozane/tazobactam (C/T) are two novel antibacterials with known efficacy against Gram-negative bacteria (GNB). We aimed to describe the efficacy and safety of surgical management combined with C/A or C/T treatment for bone and joint infections (BJIs). METHODS We conducted an observational, bicentric study of patients treated with C/A or C/T for a BJI between May 2016 and June 2019. Failure was defined as the need for unplanned additional antibiotic treatment or orthopaedic surgery, or death due to the BJI up to the patient's latest visit. RESULTS Overall, 15 patients were included. Nine patients were treated with C/A, mainly for polymicrobial BJI due to multidrug-resistant (MDR) bacteria (Enterobacteriaceae, n = 7). Six patients were male, the median age was 66 years and the median Charlson comorbidity index (CCI) was 5. It was the first septic episode at the site in 3/9 patients. The cure rate was 7/9 (median follow-up, 272 days). Two patients showed C/A-related confusion. Five patients were treated with C/T for BJI involving MDR Pseudomonas aeruginosa. Four patients were male, the median age was 53 years and the median CCI was 2. All patients had previous septic episodes at the infection site. The cure rate was 3/5 (median follow-up, 350 days). One patient was successfully treated by C/T then C/A for multistage spondylodiscitis. CONCLUSION In our experience, C/A and C/T are two effective and safe options, even as salvage treatment for BJI due to MDR-GNB despite the absence of label, however more data are warranted.
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Affiliation(s)
- Claire Rempenault
- Rheumatology Department, University Hospital of Montpellier, Montpellier, France; Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Valentine Pagis
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Latifa Noussair
- Clinical Microbiology Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Simona Berbescu
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Clara Duran
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Frédérique Bouchand
- Pharmacy Department, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Marine de Laroche
- Infectious Disease Unit, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Elsa Salomon
- Clinical Microbiology Unit, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Christophe Nich
- Orthopedic Surgery, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Thomas Bauer
- Orthopedic Surgery, Ambroise Paré University Hospital, AP-HP Paris Saclay University, Boulogne-Billancourt, France
| | - Martin Rottman
- Clinical Microbiology Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Benjamin Davido
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Morgan Matt
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Aurélien Dinh
- Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France.
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Papadopoulos A, Ribera A, Mavrogenis AF, Rodriguez-Pardo D, Bonnet E, Salles MJ, Dolores Del Toro M, Nguyen S, Blanco-García A, Skaliczki G, Soriano A, Benito N, Petersdorf S, Pasticci MB, Tattevin P, Tufan ZK, Chan M, O'Connell N, Pantazis N, Kyprianou A, Pigrau C, Megaloikonomos PD, Senneville E, Ariza J, Papagelopoulos PJ, Giannitsioti E. Multidrug-resistant and extensively drug-resistant Gram-negative prosthetic joint infections: Role of surgery and impact of colistin administration. Int J Antimicrob Agents 2019; 53:294-301. [PMID: 30395988 DOI: 10.1016/j.ijantimicag.2018.10.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/21/2018] [Accepted: 10/27/2018] [Indexed: 02/08/2023]
Abstract
Factors influencing treatment outcome of patients with Gram-negative bacterial (GNB) multidrug-resistant (MDR) and extensively drug-resistant (XDR) prosthetic joint infection (PJIs) were analysed. Data were collected (2000-2015) by 18 centres. Treatment success was analysed by surgery type for PJI, resistance (MDR/XDR) and antimicrobials (colistin/non-colistin) using logistic regression and survival analyses. A total of 131 patients (mean age 73.0 years, 35.9% male, 58.8% with co-morbidities) with MDR (n = 108) or XDR (n = 23) GNB PJI were assessed. The most common pathogens were Escherichia coli (33.6%), Pseudomonas aeruginosa (25.2%), Klebsiella pneumoniae (21.4%) and Enterobacter cloacae (17.6%). Pseudomonas aeruginosa predominated in XDR cases. Isolates were carbapenem-resistant (n = 12), fluoroquinolone-resistant (n = 63) and ESBL-producers (n = 94). Treatment outcome was worse in XDR versus MDR cases (P = 0.018). Success rates did not differ for colistin versus non-colistin in XDR cases (P = 0.657), but colistin was less successful in MDR cases (P = 0.018). Debridement, antibiotics and implant retention (DAIR) (n = 67) was associated with higher failure rates versus non-DAIR (n = 64) (OR = 3.57, 95% CI 1.68-7.58; P < 0.001). Superiority of non-DAIR was confirmed by Kaplan-Meir analysis (HR = 0.36, 95% CI 0.20-0.67) and remained unchangeable by time of infection (early/late), antimicrobial resistance (MDR/XDR) and antimicrobials (colistin/non-colistin) (Breslow-Day, P = 0.737). DAIR is associated with higher failure rates even in early MDR/XDR GNB PJIs versus implant removal. Colistin should be preserved for XDR cases as it is detrimental in MDR infections.
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Affiliation(s)
- Antonios Papadopoulos
- Fourth Department of Internal Medicine, University General Hospital 'ATTIKON', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alba Ribera
- Department of Infectious Diseases, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, University General Hospital 'ATTIKON', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dolors Rodriguez-Pardo
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Eric Bonnet
- Department of Infectious Diseases, Hôpital Joseph Ducuing, Toulouse, France
| | - Mauro José Salles
- Division of Infectious Diseases, Department of Internal Medicine, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - María Dolores Del Toro
- Infectious Diseases Unit, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - Sophie Nguyen
- Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, France
| | - Antonio Blanco-García
- Bone and Joint Infection Unit, Department of Emergency Medicine, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - Gábor Skaliczki
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Alejandro Soriano
- Department of Infectious Diseases, Hospital Clínic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Natividad Benito
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sabine Petersdorf
- Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Zeliha Kocak Tufan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Yildirim Beyazit University, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Monica Chan
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Nuala O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Kyprianou
- Fourth Department of Internal Medicine, University General Hospital 'ATTIKON', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Carlos Pigrau
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Panayiotis D Megaloikonomos
- First Department of Orthopaedics, University General Hospital 'ATTIKON', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eric Senneville
- Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, France
| | - Javier Ariza
- Department of Infectious Diseases, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedics, University General Hospital 'ATTIKON', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthymia Giannitsioti
- Fourth Department of Internal Medicine, University General Hospital 'ATTIKON', School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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Orthopedic Implant-Associated Infection by Multidrug Resistant Enterobacteriaceae. J Clin Med 2019; 8:jcm8020220. [PMID: 30744054 PMCID: PMC6406851 DOI: 10.3390/jcm8020220] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/25/2019] [Accepted: 02/04/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction: Orthopedic implant-associated infections caused by multidrug-resistant Enterobacteriaceae are a growing challenge for healthcare providers due to their increasing incidence and the difficulties of medical and surgical treatment. Material and Methods: A retrospective observational study of all cases of multidrug resistant Enterobacteriaceae orthopedic implant-associated infection diagnosed in a tertiary European hospital from December 2011 to November 2017 was carried out. Clinical records were reviewed using a previously designed protocol. Data analysis was performed with IBM® SPSS®, version 22. Results: 25 patients met inclusion criteria. The infected implants included 10 prosthetic joints, seven osteosyntheses, six combinations of prosthetic joint and osteosynthesis material, and two spacers. Of the multidrug resistant Enterobacteriaceae obtained on culture, 12 were extended-spectrum beta-lactamase-producing Escherichia coli, three OXA-48-producing Klebsiella pneumoniae, nine extended-spectrum beta-lactamase-producing Klebsiella pneumoniae, and one extended-spectrum beta-lactamase-producing Proteus mirabilis. Combination antimicrobial therapy was employed in all cases but two. Overall, 16 (64%) patients underwent implant removal. The rate of infection control in the overall implant removal group was 100% compared to 33% in the implant retention group. A strong relationship between implant removal and infection control was observed (p = 0.001). Discussion: Implant removal is strongly associated with infection control. However, in some cases, patient age and comorbidity contraindicate hardware extraction. Potential objectives for future studies should be geared towards targeting the population in which debridement, antibiotic therapy, and implant retention can be used as a first-line therapeutic strategy with a reasonable probability of achieving infection control.
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Bouige A, Fourcade C, Bicart-See A, Félicé MP, Gautie L, Krin G, Lourtet-Hascoet J, Marlin P, Giordano G, Bonnet E. Characteristics of Enterobacter cloacae prosthetic joint infections. Med Mal Infect 2019; 49:511-518. [PMID: 30691920 DOI: 10.1016/j.medmal.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/18/2017] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Enterobacter cloacae prosthetic joint infections (PJI) are rare and poorly documented. PATIENTS AND METHODS We conducted a retrospective and monocentric study in an orthopedic unit supporting complex bone and joint infections. Between 2012 and 2016 we collected background, clinical, biological, and microbiological data from 20 patients presenting with prosthetic joint infection and positive for E. cloacae, as well as data on their surgical and medical treatment and outcome. RESULTS Infections were localized in the hip (n=14), knee (n=5), or ankle (n=1). The median time between arthroplasty and septic revision was three years. Fourteen patients (70%) had undergone at least two surgeries due to previous prosthetic joint infections. The median time between the last surgery and the revision for E. cloacae infection was 31 days. Eleven patients (55%) were infected with ESBL-producing strains. The most frequently used antibiotics were carbapenems (n=9), cefepime (n=7), quinolones (n=7), and fosfomycin (n=4). The infection was cured in 15 patients (78.9%) after a 24-month follow-up. Five patients had a recurrent infection with another microorganism and four patients had a relapse of E. cloacae infection. The global success rate was 52.7% (58.3% for DAIR and 75% for DAIR+ciprofloxacin). CONCLUSION Prosthetic joint infections due to E. cloacae usually occur early after the last prosthetic surgery, typically in patients with complex surgical and medical histories. The success rate seems to be increased when DAIR is associated with ciprofloxacin.
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Affiliation(s)
- A Bouige
- Laboratoire polyvalent de biologie, hôpital Joseph-Ducuing, 15, rue Varsovie, 31300 Toulouse, France.
| | - C Fourcade
- Unité mobile d'infectiologie, hôpital Joseph-Ducuing, 15, rue Varsovie, 31300 Toulouse, France
| | - A Bicart-See
- Unité mobile d'infectiologie, hôpital Joseph-Ducuing, 15, rue Varsovie, 31300 Toulouse, France
| | - M P Félicé
- Laboratoire polyvalent de biologie, hôpital Joseph-Ducuing, 15, rue Varsovie, 31300 Toulouse, France
| | - L Gautie
- Service pharmacie, hôpital Joseph-Ducuing, 15, rue Varsovie, 31300 Toulouse, France
| | - G Krin
- Service de chirurgie orthopédique, hôpital Joseph-Ducuing, 15, rue Varsovie, 31300 Toulouse, France
| | - J Lourtet-Hascoet
- Laboratoire de biologie, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - P Marlin
- Service de chirurgie orthopédique, hôpital Joseph-Ducuing, 15, rue Varsovie, 31300 Toulouse, France
| | - G Giordano
- Service de chirurgie orthopédique, hôpital Joseph-Ducuing, 15, rue Varsovie, 31300 Toulouse, France
| | - E Bonnet
- Unité mobile d'infectiologie, hôpital Joseph-Ducuing, 15, rue Varsovie, 31300 Toulouse, France
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What’s New in the Diagnosis and Treatment of Orthopedic Prostheses-Related Infections. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2017. [DOI: 10.1007/s40506-017-0116-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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8
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Amorese V, Corda M, Donadu M, Usai D, Pisanu F, Milia F, Marras F, Sanna A, Delogu D, Mazzarello V, Manzoni G, Conti M, Meloni GB, Zanetti S, Doria C. Total hip prosthesis complication, periprosthetic infection with external fistulizing due to Enterobacter cloacae complex multiple drugs resistance: A clinical case report. Int J Surg Case Rep 2017; 36:90-93. [PMID: 28558347 PMCID: PMC5447565 DOI: 10.1016/j.ijscr.2017.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/11/2017] [Accepted: 05/14/2017] [Indexed: 12/02/2022] Open
Abstract
The incidence of periprosthetic hip infections his just below 2%, and the Enterobacteriaceae are fairly rare, being the cause of infection in 3–6% of cases. A 76 year old woman with multiple comorbidities underwent surgical implantation of endoprosthesis of the left hip. Multidisciplinary diagnosis of a rare periprosthetic infection.
Introduction The Enterobacter cloacae is a microorganism found in the intestinal flora of the majority of animals, including humans. Primary infections caused by E. cloacae are rare in immunocompetent patients, but are very common in hospital settings in newborns and immunocompromised patients, and can be aggravated by the insurgence of antibiotic resistance. The incidence of periprosthetic hip infections is just below 2%. Case presentation A 76 year old woman with multiple comorbidities underwent surgical implantation of intermediary total hip prosthesis of the left hip, in a different health facility, in February 2014, after the basicervical fracture of the upper femur extremity due to trauma. After an episode of dislocation of the prosthetic implant, in September 2014, she underwent a surgical operation to implant the acetabular component. A month later not in our facility, following a re-hospitalization for the dislocation of the arthroprosthesis, an infection from E. cloacae complex was discovered. After 2 years of chronic infection she came to our attention; the clinical picture featured coxalgia and secreting fistula in the surgical wound. Following a specific antibiotic therapy, carried out intravenously over the course of a month, we decided to intervene removing the left hip arthroprosthesis and placing an antibiotic spacer following the direction deduced from the antibiogram study of August 2016. Conclusion The patient was hospitalized in our facility and 2 months later she underwent another operation to remove the antibiotic spacer and to place a new total hip arthroprosthesis. Multiple swabs showed the complete healing from the infection, which was confirmed a couple of months later.
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Affiliation(s)
- V Amorese
- Department of Orthopaedic, University of Sassari, Sardinia, Italy
| | - M Corda
- Department of Orthopaedic, University of Sassari, Sardinia, Italy
| | - M Donadu
- Department of Biomedical Sciences, University of Sassari, Sassari, Sardinia, Italy.
| | - D Usai
- Department of Biomedical Sciences, University of Sassari, Sassari, Sardinia, Italy
| | - F Pisanu
- Department of Orthopaedic, University of Sassari, Sardinia, Italy
| | - F Milia
- Department of Orthopaedic, University of Sassari, Sardinia, Italy
| | - F Marras
- Department of Orthopaedic, University of Sassari, Sardinia, Italy
| | - A Sanna
- Department of Orthopaedic, University of Sassari, Sardinia, Italy
| | - D Delogu
- Department of Biomedical Sciences, University of Sassari, Sassari, Sardinia, Italy
| | - V Mazzarello
- Department of Biomedical Sciences, University of Sassari, Sassari, Sardinia, Italy
| | - G Manzoni
- Department of Radiology, University of Sassari, Sassari, Sardinia, Italy
| | - M Conti
- Department of Radiology, University of Sassari, Sassari, Sardinia, Italy
| | - G B Meloni
- Department of Radiology, University of Sassari, Sassari, Sardinia, Italy
| | - S Zanetti
- Department of Biomedical Sciences, University of Sassari, Sassari, Sardinia, Italy
| | - C Doria
- Department of Orthopaedic, University of Sassari, Sardinia, Italy
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