[A vertebral polymicrobial osteomyelitis with atypicial microorganisms: A case report]. / Spondylodiscite, une bactérie peut en cacher une autre. Actualisation de la stratégie diagnostique et de suivi.

Vertebral Osteomyelitis (VO) is a rare disease, which has seen a gradual increase in its incidence over the past years. Here, we report a case, showing how difficult it can be to diagnose and manage a therapy in case of atypical microorganism. A 68-year-old man was hospitalized for a VO documented by blood cultures at Bacteroides fragilis. He first progressed favorably, but an increase in lumbar pain prompted, after an IRM, a percutaneous needle biopsy (PNB) that documented a recurrent VO at Corynebacterium striatum. In the face of this multi-microbial VO with atypicals microorganisms, a first PNB could have been discussed despite the positive blood cultures. This case report illustrates the complexity of management of VO, and its evolution according to the latest recommendations (interest of RMI during the follow-up, place of the TEP-scan, terms and conditions of immobilization, antibiotic administration methods).

Hip Joint Infections Caused by Multidrug-Resistant Enterobacterales Among Patients With Spinal Cord Injury: Experience of a Reference Center in the Greater Paris Area.

Background: We aimed to describe the management and treatment of hip joint infections caused by multidrug-resistant Enterobacterales among patients with spinal cord injury (SCI). Methods: We included all hip joint infections associated with grade IV decubitus ulcers caused by extended-spectrum beta-lactamase producing Enterobacterales (ESBL-PE) and carbapenemase-producing Enterobacterales treated in a reference center for bone and joint infections over 9 years in a retrospective study. Results: Seventeen SCI patients with ischial pressure ulcers breaching the hip capsule (mean age 52 ± 15 years) were analyzed. In 16 patients, paraplegia was secondary to trauma and 1 was secondary to multiple sclerosis. Infections were mostly polymicrobial (n = 15; 88.2%), notably caused by Klebsiella pneumoniae (n = 10) and Staphylococcus aureus (n = 10). The carbapenemases identified were exclusively OXA-48-type (n = 3) including 2 isolates coexpressed with ESBL-PE within the same bacterial host. Multidrug-resistant Enterobacterales were commonly resistant to fluoroquinolones (n = 12; 70.6%). Most therapies were based on carbapenems (n = 10) and combination therapies (n = 13). Median duration of treatment was 45 (6-60) days. Of 17 cases of hip joint infections, 94.1% (n = 16) benefited from a femoral head and neck resection. Infection control was initially achieved in 58.8% (n = 10) of cases and up to 88.2% after revision surgeries, after a median follow-up of 3 (1-36) months. Conclusions: Hip infections among SCI patients caused by multidrug-resistant Enterobacterales are often polymicrobial and fluoroquinolones-resistant infections caused by Klebsiella pneumoniae and S aureus, highlighting the need for expert centers with pluridisciplinary meetings associating experienced surgeons, clinical microbiologists, and infectious disease specialists.

Native bone and joint infections caused by extended-spectrum ß-lactamase-producing Enterobacterales: experience of a reference centre in the Greater Paris area.

Antibiotic treatment of native osteomyelitis caused by extended-spectrum ß-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.

Case series of carbapenemase-producing Enterobacteriaceae osteomyelitis: Feel it in your bones.

OBJECTIVES: Limited data have been reported regarding osteomyelitis due to carbapenemase-producing Enterobacteriaceae (CPE), including co-infections with extended-spectrum ß-lactamase (ESBL)-producing micro-organisms. METHODS: We conducted a retrospective study in a reference centre for bone and joint infections from 2011 to 2019 among patients infected with CPE. RESULTS: Nine patients (mean age 46.8 ± 16.6 years), including three with infected implants, were identified. Infections were mostly polymicrobial (n = 8/9), including Staphylococcus aureus (n = 6/9). CPE were mainly OXA-48-type, associated with ESBL-producing Enterobacteriaceae (n = 8/9), of which 5/9 isolates were Klebsiella pneumoniae. Control of the infection was achieved in seven cases. CONCLUSIONS: CPE osteomyelitides are essentially polymicrobial and fluoroquinolone-resistant infections, highlighting the need for efficient surgery with implant removal.

Successful treatment of meningococcal bacteremia using oral doxycycline: A case report.

We report the case of an 18-year-old immunocompetent man who presented to the hospital with fever, headaches, and arthromyalgia, which progressed to include an erythematous rash. He had a history of a tick bite 72 h earlier. The diagnosis of rickettsial infection was suspected and a course of doxycycline was initiated for a total of 5 days. His evolution was rapidly favorable under treatment, with resolution of the symptoms within 24 h. Blood cultures came back positive for Neisseria meningitidis serotype B, indicating an authentic purpura fulminans. Purpura fulminans is a medical emergency, a syndrome of intravascular thrombosis characterized by a very rapid evolution that requires early recognition and specific treatment. It is commonly described in the young and healthy patient and has high mortality and morbidity. Common bacteria mainly associated with purpura fulminans are Meningococcus spp., Pneumococcus spp., and Staphylococcus spp.

Veillonella parvula spondylodiscitis.

OBJECTIVES: Veillonella parvula is an anaerobic Gram-negative coccus rarely involved in bone and joint infections. PATIENTS AND METHOD: We report the case of a Veillonella parvula vertebral osteomyelitis (VO) in a female patient without any risk factor. RESULTS: The 35-year-old patient was immunocompetent and presented with Veillonella parvula VO. She was admitted to hospital for inflammatory lower back pain. The discovertebral sample was positive for Veillonella parvula. Literature data on Veillonella VO is scarce. Reported cases usually occurred in immunocompromised patients. Diagnosis delay can be up to four months. Patients are usually afebrile. Outcome with antimicrobial treatment alone is favorable in half of cases. Other patients must undergo surgery. CONCLUSIONS: Veillonella VO may occur in immunocompetent patients and have a clinical spectrum of mechanical lower back pain.

Frequency and epidemiology of extended-spectrum ß-lactamase-producing Enterobacteriaceae isolates susceptible to third-generation cephalosporins or to aztreonam.

OBJECTIVE: We evaluated among 400 strains of extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBLE) the rate of strains categorized as intermediate or resistant to 3rd generation cephalosporins or aztreonam according to the 2011 guidelines of the French Society of Microbiology Antibiogram Committee. MATERIAL AND METHODS: MICs of cefotaxime, ceftazidime, cefepime or aztreonam were determined by the E-test method for isolates with susceptible zones to these antibiotics. RESULTS: Overall, 109/400 (27.3%) isolates were susceptible to at least one of these 4 agents. Notably, 21.8% of Escherichia coli isolates were susceptible to ceftazidime, and 21.1% of Klebsiella pneumoniae isolates were susceptible to cefepime. Discrepancies between categorization by disk diffusion and MIC determination were observed for aztreonam and cefepime. CONCLUSION: These results indicate alternatives to carbapenems for treating infections caused by ESBLE.

[Obtention of bacterial antibiotic susceptibility following standard conditions directly from infected biological fluids and positive blood cultures]. / Mesure de la sensibilité aux antibiotiques selon les conditions standards directement à partir de liquides biologiques infectés et d'hémocultures positives.

OBJECTIVE: Determining the conditions, which would allow us to apply bacterial antibiotic susceptibility tests directly to infected biological fluids and positive blood cultures and in accordance with the standard conditions of these tests. METHODS: For infected fluids (N=23), a correlation was determined between the bacterial count observed by microscopic field on a cystopin centrifugation pellet and the dilution required to obtain bacterial inocula corresponding to those used in the standard antibiogram and E-test methods. For blood cultures detected positive with the BactALERT system (26 Enterobacteriaceae, 29 Staphylococcus and 11 Pneumococcus), the broth dilution required to obtain such inocula was determined for each bacterial type. RESULTS: For infected fluids, the dilution required for the antibiogram of enterobacterial and staphylococcal isolates was respectively of 10(-1) and 10(0) when there were 50 to 100 bacteria/field, 10(-2) and 10(-1) for 100 to 500, 10(-3) and 10(-2) for 500 to 1000, and 10(-4) and 10(-3) for>1000. A minimum of 50 to 100 bacteria/field was required to determine beta-lactam MICs towards a pneumococcal isolate present in cerebrospinal fluid. For blood cultures, a broth dilution of 10(-4) for Enterobacteriaceae and of 10(-2) for Staphylococcus and Pneumococcus allowed to reproduce the standard antibiogram. To reproduce the standard conditions of the E-test method for beta-lactam MICs towards a pneumococcal isolate, the broth dilution was 10(-1). CONCLUSION: Following the procedure described, antibiotic susceptibility can be available 24 h earlier.