Unusual Presentation of Lumbar Surgical Site Infection: A Case Study of Early Onset Pasteurella multocida Infection after Arthrodesis.

BACKGROUND Infection is a serious surgical complication that significantly increases morbidity rates and health care expenses. Most human Pasteurella multocida infections are soft-tissue infections caused by dog or cat bites. Pasteurella multocida (P. multocida) is present in the oral, nasopharyngeal, and upper respiratory tract microbiota among cats, dogs, and other domestic or wild animals. Here, we report a case of lumbar surgical site infection caused by this bacterium. CASE REPORT A 70-year-old diabetic and overweight woman had a Pasteurella multocida surgical site infection after lumbar arthrodesis carried out for lumbar stenosis associated with spondylolisthesis. The patient had been in contact with her cat and claimed to have simply slept with it in her bed. Multiple antibiotic therapies and 3 debridement-irrigations with change of spinal implants during the last revision were needed. CONCLUSIONS Infections caused by P. multocida are rare and most often occur as a result of animal scratches or bites, but can sometimes occur after simple contact with an animal. Surgical site infection of spinal arthrodesis due to Pasteurella multocida implies treatment difficulties. In case of Pasteurella multocida infection of lumbar spinal arthrodesis, even in the early period, implant removal seems to be useful to limit the appearance of biofilm more specific to this micro-organism.

Characteristics and outcomes of cerebrospinal fluid shunt and drain-associated infections.

INTRODUCTION: Data on infections associated with cerebrospinal fluid shunt (CSF-S) or device-associated infection (CSF-SDI) are limited in adults. We performed a retrospective study to describe characteristics, management, and outcome of CSF-SDI. METHODS: All patients with CSF-SDI and admitted to our institution from January 2013 to December 2019 were included. RESULTS: Among 50 patients, fifty-six episodes of CSF-SDI (41 external ventricular device-associated infections (CSF-D) and 15 other shunt infections (CSF-S) were included. The incidence of CSF-SDI was 11.9 %. Fever was the most common symptom (81 %). Enterobacterales were more prevalent in CSF-S than in CSF-D (20 % vs 53 %, p = 0.02). As regards CSF-D, deceased patients (11/41, 27 %) more frequently had a Glasgow coma scale score decreasing from baseline (p < 0.01), lower glycorrhachia (p < 0.01), a higher protein level in CSF (p = 0.001) and a positive control CSF culture (p = 0.031). CONCLUSIONS: CSF-SDIs are rare but with a high mortality rate. Mortality was more closely related to the infection than to comorbidities or underlying neurosurgical disease. A second CSF analysis significantly helped to detect patients with CSF-D with a poor prognosis.

Is blood lymphocyte count a prognostic biomarker in Staphylococcus aureus bacteremia?

Lymphopenia is common in patients with sepsis and associated with mortality. Immune-stimulatory therapies likely to restore T-cells count and function are under investigation in sepsis. Our study aimed to assess whether lymphopenia is a reliable prognostic biomarker in Staphylococcus aureus bacteremia. We conducted an ancillary study of the prospective VIRSTA Study including 574 patients with S. aureus bacteremia in two tertiary care centers. Neither lymphocyte count at the onset nor lymphocyte change during the first 4 days was associated with 12-week mortality. These results highlight the importance of characterizing the immune profile of patients with sepsis according to the cause before investigating immunostimulatory therapies to restore lymphocyte proliferation and function.

Epidemiology and risk factors of nasal carriage of Staphylococcus aureus CC398 in two distinct cohorts in France.

Background: We aimed to determine the prevalence and factors associated with nasal carriage of Staphylococcus aureus CC398 in the community and among hospitalized patients. Methods: We conducted a prospective cohort study in a French university hospital and a cross-sectional study in the surrounding region. Results: From June 2019 to July 2020, 591 healthy blood donors (HBDs) and 647 hospitalized patients (HPs) were included. S. aureus CC398 was more prevalent in HBDs than in HPs (7.3% [5.3-9.7] vs. 3.8% [2.4-5.5], p = 0.006). Among S. aureus nasal carriers, the prevalence of CC398 isolates was 24.6% in HBDs and 18.3% in HPs (p = 0.19). No MRSA belonged to CC398. In multivariate analysis, prior antibiotic intake in the past year (OR 3.11 [1.37-7.06]) and active smoking (OR 3.01 [1.00-9.05]) were associated with S. aureus CC398 nasal carriage in the HBD cohort. A history of neurological disease was associated with nasal carriage (OR = 5.43 [1.21-24.2]), whereas an age between 82 and 90 years (OR 0.11 [0.02-0.54]) and diabetes (OR 0.18 [0.04-0.85]) were protective factors in the HP cohort. Contact with livestock was not a risk factor in either cohort. Conclusion: The prevalence of MSSA CC398 was higher in the community than hospitalized patients. Factors associated with nasal carriage of MSSA CC398 were primarily related to general preconditions. No environmental sources of exposure were identified.