Applying local vancomycin with vacuum-assisted closure on decubitus isolated Corynebacterium striatum: a case report

Abstract

Introduction:The infections of decubitus are generally polymicrobial. infection. After debridement and control of infection, decubitus treatment continues with regeneration of tissue loss. Vacuum assisted closing (VAC) is a treatment option in these situations. We aimed to reveal local antibiotic treatment of decubitus infection with C. Striatum which was resistant to first generation antibiotics, with vancomycin instillated in VAC device, in this case. Case Presentation: 77 years old patient with Alzheimer, Parkinson and diabetes mellitus residented in was hospitalized in palliative care unit for decubitus and nutrition disorder. Decubitus with necrosis was present in sacral region. The Ampirical antibiotherapy with ciprofloxacin for decubitus infection was given to the patient whose hematologic parameters detected during hospitalization were normal. VAC application was performed after debridement of necrotic tissues. C. Striatum resistant to first generation antibiotics was identified in wound culture. Contamination was suspected cause the patient's general status was good, inflamation marker levels were moderate and C. Striatumun is existing in normal skin flora. Ciprofloxacin was stopped as C. Striatum was isolated again in the culture taken from the middle of wound and was determined sensitive to linezoid and vancomycin and resistant to other antibiotics. Treatment was continued with vancomycin added to VAC device. No bacteria was detected in control cultures. Conclusion: Decubitus wound infections are generally polymicrobial and treated with systemic or local treatments. Multi resistant C. Striatum reproduction as in this case is usually isolated in immunosupressive patients with long hospitalization period, patients using prolonged large spectrum antibiotics and in intensive care units. It was presented with this case that successfull resuIts could be achieved by local performing of advanced antibiotic that the microorganism is sensitive in the treatment of seconder infection developed in decubitus ulcer of the patient who had no sepsis signs. ÖZGiriş: Bası ülserlerinin enfeksiyonu genellikle polimikrobiyaldir. Tedavisine debridman ve enfeksiyonun kontrolü ile başlanılarak ülsere kısmın doku kaybının yeniden oluşturulması gerekir. Bu amaçla vakum yardımlı kapama (VAK) yöntemi tedavide bir seçenektir. Bu olguda, birinci basamak antibiyotiklere dirençli Corynebacterium striatum üreyen bası yarasında VAK uygulaması esnasında VAC ile eş zamanlı olarak verilen vankomisin eklenmiş yıkama suyunun lokal uygulamasının faydalı olabileceğini göstermeyi amaçladık. Vaka Sunumu: Huzurevinde kalan 77 yaşında Alzheimer, Parkinson ve diyabet tanısı olan kadın hasta beslenme bozukluğu ve bası yarası nedeniyle palyatif bakım servisine yatırıldı. Sakrum bölgesinde nekrotik görünümlü dekübit ülseri mevcut idi. Yatış esnasında yapılan rutin kan tahlilleri normal olan hastanın dekübit enfeksiyonuna yönelik ciprofloxacin ampirik antibiyotik tedavisi başlandı. Nekrotik kısımların debridmanı sonrası VAK uygulamasına başlandı. Yara ...