RESUMO
INTRODUCTION: Cutibacterium acnes is a commensal bacterium of the skin, frequently reported in prosthetic shoulder or spinal implant infections, but rarely in cranial and intracranial infections. METHODS: We retrospectively reviewed patients with intracranial samples positive to Cutibacterium acnes managed in the neurosurgical units of our hospital of Lyon, France, between 2008-2016. RESULTS: We included 29 patients, of whom 23 had empyema (with or without abscess), 17 had cranial osteomyelitis, and six only had abscess. Prior neurosurgery was reported in 28 patients, and the remaining patient had four spontaneous abscesses. Twelve patients had polymicrobial infections, including methicillin-susceptible Staphylococcus in 11 cases. The clinical diagnosis was difficult because of indolent and delayed symptoms: a CT scan or MRI was required. Thirteen patients (52%) had material at the infection site. All patients with bone flap implant or bones from biological banks had a bone flap-associated infection. Drainage was surgically performed in 25 cases or by CT scan-guided aspiration in four cases. All patients received an adapted antibiotic therapy (from three weeks to six months). The outcome was favorable in 28 patients. Three patients relapsed during the antibiotic therapy, requiring further surgery. CONCLUSION: Cutibacterium acnes can be responsible for postoperative empyema and cerebral abscesses, with particular indolent forms, which make their diagnosis difficult. They are often polymicrobial and associated with bone flap osteomyelitis. Their outcome is favorable after drainage and adapted antibiotic therapy.
Assuntos
Abscesso Encefálico/microbiologia , Craniotomia/efeitos adversos , Empiema/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Propionibacteriaceae/isolamento & purificação , Infecção da Ferida Cirúrgica/microbiologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/epidemiologia , Abscesso Encefálico/terapia , Coinfecção/epidemiologia , Coinfecção/microbiologia , Terapia Combinada , Diagnóstico Tardio , Drenagem , Resistência Microbiana a Medicamentos , Empiema/diagnóstico por imagem , Empiema/epidemiologia , Empiema/terapia , Feminino , Seguimentos , Infecções por Bactérias Gram-Positivas/diagnóstico por imagem , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Neuroimagem , Osteomielite/epidemiologia , Osteomielite/microbiologia , Propionibacteriaceae/efeitos dos fármacos , Propionibacteriaceae/patogenicidade , Estudos Retrospectivos , Pele/microbiologia , Crânio/microbiologia , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/terapia , VirulênciaRESUMO
OBJECTIVE: to describe the management and control of a limited outbreak of carbapenem-resistant Acinetobacter baumanii (CRAB) outbreak in a French intensive care unit. METHODS: Careful review of the contact's and carrier's files and outbreak management procedures. RESULTS: An undiagnosed CRAB carrier was admitted to our intensive care unit after medical evacuation from Turkey. Despite preventive isolation and contact precautions, a secondary case was diagnosed 5 days after admission of the index case and resulted in the creation of a crisis unit. Prompt management included an epidemiologic investigation with contact screening and follow-up, environmental screening, and additional restrictive measures: isolation room, closure of adjacent rooms, patient cohorting with designated nurses, and reinforcement of contact precautions. CONCLUSIONS: restrictive management of CRAB outbreaks may allow prompt outbreak control and avoid prolonged room closures.