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Abstract Introduction Staphylococcus aureus frequently causes infections in outpatient and hospital settings and can present as a highly variable entity. Typical manifestations are endocarditis, osteoarticular infections or infection of implanted prostheses, intravascular devices or foreign bodies. A thorough diagnostic evaluation with early focus identification is mandatory to improve patient outcome. Case report We report a case of a 68-year old patient with a history of double allogeneic stem cell transplant for acute myeloid leukemia who developed a S. aureus bacteremia with dissemination, severe sepsis and lethal outcome due to nasal handkerchief packing after nose bleeding. Conclusion A thorough medical examination with further diagnostic work-up is most important in S. aureus blood stream infection to identify and eradicate the portal(s) of entry, to rule out endocarditis, to search for spinal abscesses, osteomyelitis or spondylodiscitis. Adherence to management guides for clinicians must be of major importance to achieve optimal quality of clinical care, and thus improve patient outcome.…

Abstract Background Aerococcus urinae is a gram-positive, alpha-hemolytic coccus bacterium primarily implicated in less than 1 % of all symptomatic urinary tract infections. Risk factors for disease include male gender, advanced age, and comorbid genitourinary tract pathology. Infections beyond the genitourinary tract are rare, though spondylodiscitis, perineal abscesses, lymphadenitis, bacteremia, meningitis, and endocarditis have been reported. Less than fifty cases of A. urinae infective endocarditis (IE) have been described in the literature. The rare occurrence of A. urinae in human infections and resultant lack of randomized controlled trials have resulted in a significant degree of clinical uncertainty in the management of A. urinae IE. Case presentation We present an unusual case of a forty-three year-old male with A. urinae infective endocarditis (IE) who was successfully treated with mitral valve replacement and six weeks of penicillin/gentamicin therapy. In addition, we include a comprehensive review of all reported cases of IE due to A. urinae with specific attention to therapeutic regimens and treatment durations. Conclusion Recent advances in diagnostic technology have led to an increase in the frequency A. urinae is diagnosed. Reviewing cases of Aerococcus urinae infections, their clinical courses and subsequent management can assist future healthcare providers and their patients.…

Manfredi Gagliano, Costanza Marchiani, Giulia Bandini, Paolo Bernardi, Nicolas Palagano, Elisa Cioni, Martina Finocchi, Silvia Bellando Randone, Alberto Moggi Pignone

Spondylodiscitis are infections whose incidence has been rising through an increase in the susceptible population and improved diagnostic skills. Fungal spondylodiscitis is uncommon (0.5%–1.6%) and usually due to Candida albicans (Gouliouris et al., 2010; Berbari et al., 2015). Candida glabrata, formerly known as Torulopsis glabrata, is a common saprophyte in the gastrointestinal, genitourinary, and respiratory tracts and an opportunistic pathogen of low virulence (Berkowitz et al., 1979). Infections caused by C.

Abstract Background Most guidelines recommend 6 to 12 weeks of parenteral antibiotic treatment for pyogenic spondylodiscitis. When surgical debridement is adequately performed, further intravenous antibiotic treatment duration can be reduced than that of conservative treatment alone theoretically. However, the appropriate duration of post-surgical parenteral antibiotic treatment is still unknown. This study aimed to identify the risk factors of recurrence and evaluate the appropriate duration after surgical intervention. Methods This 3-year retrospective review included 102 consecutive patients who were diagnosed with pyogenic spondylodiscitis and underwent surgical intervention. Recurrence was defined as recurrent signs and symptoms and the need for another unplanned parenteral antibiotic treatment or operation within one year. This study included two major portions. First, independent risk factors for recurrence were identified by multivariable analysis, using the database of demographic information, pre-operative clinical signs and symptoms, underlying illness, radiographic findings, laboratory tests, intraoperative culture results, and treatment. Patients with any one of the risk factors were considered high-risk; those with no risk factors were considered low-risk. Recurrence rates after short-term (≤3 weeks) and long-term (> 3 weeks) parenteral antibiotic treatment were compared between the groups. Results Positive blood culture and paraspinal abscesses were identified as independent risk factors of recurrence. Accordingly, 59 (57.8%) patients were classified as low-risk and 43 (42.2%) as high-risk. Among the high-risk patients, a significantly higher recurrence rate occurred with short-term than with long-term antibiotic therapy (56.2% vs. 22.2%, p = 0.027). For the low-risk patients, there was no significant difference between short-term and long-term antibiotic therapy (16.0% vs. 20.6%, p = 0.461). Conclusions The appropriate duration of parenteral antibiotic treatment in patients with pyogenic spondylodiscitis after surgical intervention could be guided by the risk factors. The duration of postoperative intravenous antibiotic therapy could be reduced to 3 weeks for patients without positive blood culture or abscess formation.…

Abstract Background The classic Lemierre’s syndrome refers to a septic thrombosis of the internal jugular vein, usually caused by a Fusobacterium necrophorum infection starting in the oral cavity, and typically complicated by pulmonary emboli. However, unusual forms of the disorder have been rarely reported. Case presentation We describe an unusual case of a previously healthy 58-year-old male with Lemierre’s syndrome, manifesting with lumbar pain and fever. A thrombosis of the iliac veins and abscesses in the right iliac and the left psoas muscles was diagnosed by a computed tomography scan, together with a right lung pneumonia complicated by pleural effusion and an L4-L5 spondylodiscitis. Blood culture and pus drainage were positive for Fusobacterium nucleatum and an atypical Lemierre’s syndrome was suspected. The patient was treated with anticoagulant therapy for 12 weeks and intravenous antibiotic therapy for 6 weeks with a good evolution and resolution of the thrombosis. Conclusions This case illustrates the thrombogenic and thromboembolic tendency of Fusobacterium nucleatum and its potential invasiveness, regardless of the site of primary infection. The concept of an atypical Lemierre’s syndrome is redefined here to take into consideration non-cervical sites.…

M. Gagliano, L.R. Suardi, C. Marchiani, G. Bandini, N. Palagano, E. Cioni, A. Moggi Pignone

Jeroen G.V. Habets J, Onno P.M. Teernstra, Wouter L.W. van Hemert, Catharina K. Linssen, Roel J.J. Heijboer, Kim Rijkers

Abstract Introduction Many clinical manifestations can be related to Tropheryma whipplei infection. Case report We report a Tropheryma whipplei limbic encephalitis developed as a relapse of classical Whipple’s disease. Discussion This case is to the best of our knowledge the first proof of the effective brain–blood barrier crossing of both doxycycline and hydroxychloroquine as demonstrated by direct concentration monitoring on brain biopsy.…

Abstract Purpose Dalbavancin is a novel lipoglycopeptide with potent activity against several gram-positive pathogens, an excellent safety profile and a long elimination half-life. Methods In this case series observed at the University Hospital of Vienna between 2015 and 2017, all adult patients with gram-positive infections who received at least one dosage of dalbavancin were screened (n = 118). A total of 72 patients were included in the final analysis. The number of included patients stratified by the source of infection was: skin and soft tissue infection (SSTI) (n = 26), osteomyelitis (n = 20), spondylodiscitis (n = 14), acute septic arthritis (n = 4) and prosthetic joint infection (n = 8). Results In 46 patients (64%), clinical cure was detected at the end of dalbavancin therapy without additional antibiotic therapy. Of the 26 patients who received additional antibiotic therapy other than dalbavancin, 15 patients (21%) showed no clinical improvement under dalbavancin therapy, four patients (5%) had side effects (nausea n = 1, exanthema n = 2, hyperglycemia n = 1), and in seven patients (10%) clinical improvement under dalbavancin therapy was detected but antibiotic therapy was de-escalated to an oral drug. Conclusion We demonstrated high clinical effectiveness of dalbavancin for acute gram-positive infections primarily acute SSTI, acute septic arthritis, acute osteomyelitis and spondylodiscitis. In patients with biofilm-associated infection (chronic infection or joint prosthesis), source control was absolutely necessary for treatment success.…

Morata, L., Cobo, J., Fernandez-Sampedro, M., Vasco, P. G., Ruano, E., Lora-Tamayo, J., Sanchez Somolinos, M., Ruano, P. G., Nieto, A. R., Arnaiz, A., Estebanez Munoz, M., Jimenez-Mejias, M. E., Lozano Serrano, A. B., Munez, E., Rodriguez-Pardo, D., Argelich, R., Arroyo, A., Barbero, J. M., Cuadra, F., Del Arco, A., del Toro, M. D., Guio, L., Jimenez-Beatty, D., Lois, N., Martin, O., Martinez Alvarez, R. M., Martinez-Marcos, F. J., Porras, L., Ramirez, M., Vergas Garcia, J., Soriano, A.

Background: Dalbavancin is a lipoglycopeptide with potent activity against gram-positive microorganisms, with a long half-life, favorable safety profile and a high bone concentration which makes it an interesting alternative for osteoarticular infections.Patients and Methods: Multicentric retrospective study of all patients with an osteoarticular infection (septic arthritis, spondylodiscitis, osteomyelitis or orthopedic implant related infections) treated with at least one dose of dalbavancin between 2016 and 2017 in 30 institutions in Spain. In order to evaluate the response, patients with or without an orthopedic implant were separated.Results: A total of 64 patients were included. S. epidermidis and S. aureus were the most frequent microorganism. The reasons for switching to dalbavancin were simplification (53.1%), adverse events (25%), or failure (21.9%). There were 7 adverse events and none patient had to discontinue dalbavancin. In 45 cases infection was related to an orthopedic implant. The material was retained in 23 cases, 15 (65.2%) were classified as cured and 8 (34.8%) presented improvement. In 21 cases the implant was removed and 16 (76.2%) were considered as success, 4 (19%) as improvement and 1 (4.8%) as failure. Among the 19 cases without implants 14 (73.7%) were considered cured, 3 (15.8%) as improvement and 2 (10.5%) as failures.Conclusion: The results show that dalbavancin is a well-tolerated antibiotic, even when administering > 2 doses, and is associated with a high cure rate. This is preliminary data with a short follow-up, therefore, it is necessary to have more experience and in the future to establish the most appropriate dose and frequency.…

Safia Nadji, Marie-Charlotte Chopin, Camille Bourdon, R. Desbarbieux, Jean-Marie Marissael, Sylvie Armand, Frédéric Wallet, Caroline Loiez

Abstract Introduction Aerococccus urinae (AU) is a pathogen mainly identified in male urinary tract infections and responsible for bacteremia and endocarditis. To the best of our knowledge, there are only five patients with osteomyelitis due to AU described in the literature. All of them had urinary tract disease or systemic conditions such as diabetes, and two were associated with an endocarditis. Case report We described the first case of isolated spondylodiscitis without general or local predisposing condition, excepted age > 65 years.…