Chronic Bone Infections Due to<i>Enterobacter cloacae</i>: Current Therapeutic Trends and Clinical Outcome

Kanellakopoulou, K.; Giannitsioti, Efthymia; Papadopoulos, Anthony; Athanassia, Sofia; Giamarellos‐Bourboulis, Evangelos J.; Giamarellou, Helen

doi:10.1179/joc.2009.21.2.226

Cited by 6 publications

(5 citation statements)

References 9 publications

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“…In our study, when E cloacae infections and infections caused by other microorganisms were compared, patients with E cloacae infection were significantly older (64.38 vs 52.77). However, in contrast with previous studies, 2,7 there were no significant differences with other patient-dependent variables and comorbidities.…”

Section: Discussioncontrasting

confidence: 99%

“…Bouige et al 2 analyzed 20 patients with prosthetic joint infection caused by E cloacae and observed that patients had a mean age of 70.5 years and 25% had obesity (BMI more than 35) whereas 75% presented comorbidities. Kanellakopoulou et al 7 analyzed a series of 15 cases of chronic osteomyelitis caused by E cloacae . In this case series, the mean age was lower than in other studies (52.8 years), but 40% of the patients were diagnosed with diabetes mellitus, which differs from our study, where a lower incidence of 28.57% in patients with E cloacae infection was observed.…”

Section: Discussionmentioning

confidence: 99%

“…They are also observed in patients with a prolonged hospital stay and antibiotic treatment, especially in intensive care units. 4,20 In traumatology, its incidence has been reported in chronic osteomyelitis, 7,19,28 prosthetic infections, 2,5 septic osteoarthritis, 6 open traumatism in children 11 and adults, 30 and in fractures 3,29 other than the ankle.…”

Section: Introductionmentioning

confidence: 99%

“…In traumatology, its incidence has been reported in chronic osteomyelitis, 7,19,28 prosthetic infections, 2,5 septic osteoarthritis, 6 open traumatism in children 11 and adults, 30 and in fractures 3,29 other than the ankle.…”

Section: Introductionmentioning

confidence: 99%

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Enterobacter cloacae Infection After Surgical Treatment of Ankle Fractures, a Multicenter Observational Study

et al. 2023

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Background: Infection is one of the challenging complications after open reduction and internal fixation for ankle fractures. Previously published case series conclude that Staphylococcus aureus is the most frequent causative microorganism. An unexpected increase in Enterobacter cloacae infections after this surgery was observed in a preliminary analysis of data at the promoting center of the study. In traumatology, its incidence has been reported in chronic osteomyelitis, prosthetic infections, septic osteoarthritis, open fractures in children and adults, and fractures other than the ankle. Because of this unexpected finding, we decided to perform this study to analyze the demographic and microbiological variables of acute osteosynthesis infection after ankle fracture and determine the distinctive features of the patients with E cloacae infection. Methods: We performed a retrospective multicenter study including 4 university hospitals. All patients diagnosed with acute osteosynthesis infection after ankle fracture fixation between January 2015 and December 2018 were included. We analyzed demographic data, type of fracture, surgical technique, and microorganisms responsible for the infection. We performed a descriptive statistical analysis of the variables. Univariate and multivariate regression analysis were performed to compare patients with E cloacae infection to patients with infection caused by other microorganisms. Results: A total of 65 patients were included. A predominance of polymicrobial infections (24.62%), followed by infections caused by S aureus (23.07%) and E cloacae (23.07%) was observed. When E cloacae isolated in polymicrobial infections were added, the incidence of E cloacae as a causative microorganism increased to 32.3%. Patients with E cloacae infection were older (64/53, P = .008) and had a higher requirement of negative-pressure therapy after surgical debridement (71%/40%, P = .017). Conclusion: A high incidence of E cloacae infections was observed. Patients with E cloacae infection were generally older and required a higher use of negative-pressure therapy after debridement. Level of Evidence: Level V, mechanism-based reasoningr.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Enterobacter cloacae Infection After Surgical Treatment of Ankle Fractures, a Multicenter Observational Study

et al. 2023

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“…Although Gram-positive cocci are the most implicated pathogens in osteomyelitis (Uçkay et al, 2012), Gramnegative bacteria (GNB) emerge as causative agents in 10 %-20 % of cases in the form of mono-or polymicrobial osteoarticular infections (Benito et al, 2016). Case series (with or without implantable devices) have been reported (Kanellakopoulou et al, 2009;Legout et al, 2006;Titécat et al, 2013), but most cases refer to prosthetic joint infection (PJI) (Benito et al, 2016), Nowadays, the emergence of multidrugresistant (MDR) or even extensively drug-resistant (XDR) GNB, especially among Enterobacterales, bears novel diagnostic and therapeutic challenges worldwide. In a case series of chronic osteomyelitis during last decade, the incidence of MDR GNB was shown to increase over the years (Koutserimpas et al, 2018), but data on orthopaedic implants are limited.…”

Section: Introductionmentioning

confidence: 99%

Osteosynthesis-associated infection of the lower limbs by multidrug-resistant and extensively drug-resistant Gram-negative bacteria: a multicentre cohort study

Giannitsioti

Salles²,

Mavrogenis³

et al. 2022

J. Bone Joint Infect.

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Abstract. Purpose: The purpose of this study was the clinical and therapeutic assessment of lower-limb osteosynthesis-associated infection (OAI) by multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacteria (GNB), which have been poorly studied to date. Methods: A prospective multicentre observational study was conducted on behalf of ESGIAI (the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Implant-Associated Infections). Factors associated with remission of the infection were evaluated by multivariate and Cox regression analysis for a 24-month follow-up period. Results: Patients (n=57) had a history of trauma (87.7 %), tumour resection (7 %) and other bone lesions (5.3 %). Pathogens included Escherichia coli (n=16), Pseudomonas aeruginosa (n=14; XDR 50 %), Klebsiella spp. (n=7), Enterobacter spp. (n=9), Acinetobacter spp. (n=5), Proteus mirabilis (n=3), Serratia marcescens (n=2) and Stenotrophomonas maltophilia (n=1). The prevalence of ESBL (extended-spectrum β-lactamase), fluoroquinolone and carbapenem resistance were 71.9 %, 59.6 % and 17.5 % respectively. Most patients (n=37; 64.9 %) were treated with a combination including carbapenems (n=32) and colistin (n=11) for a mean of 63.3 d. Implant retention with debridement occurred in early OAI (66.7 %), whereas the infected device was removed in late OAI (70.4 %) (p=0.008). OAI remission was achieved in 29 cases (50.9 %). The type of surgery, antimicrobial resistance and duration of treatment did not significantly influence the outcome. Independent predictors of the failure to eradicate OAI were age >60 years (hazard ratio, HR, of 3.875; 95 % confidence interval, CI95 %, of 1.540–9.752; p=0.004) and multiple surgeries for OAI (HR of 2.822; CI95 % of 1.144–6.963; p=0.024). Conclusions: Only half of the MDR/XDR GNB OAI cases treated by antimicrobials and surgery had a successful outcome. Advanced age and multiple surgeries hampered the eradication of OAI. Optimal therapeutic options remain a challenge.

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Multidrug-resistant and extensively drug-resistant Gram-negative prosthetic joint infections: Role of surgery and impact of colistin administration

Παπαδοπουλοσ

Ribera

Mavrogenis

et al. 2019

International Journal of Antimicrobial Agents

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Chronic Bone Infections Due toEnterobacter cloacae: Current Therapeutic Trends and Clinical Outcome

Cited by 6 publications

References 9 publications

Enterobacter cloacae Infection After Surgical Treatment of Ankle Fractures, a Multicenter Observational Study

Enterobacter cloacae Infection After Surgical Treatment of Ankle Fractures, a Multicenter Observational Study

Osteosynthesis-associated infection of the lower limbs by multidrug-resistant and extensively drug-resistant Gram-negative bacteria: a multicentre cohort study

Multidrug-resistant and extensively drug-resistant Gram-negative prosthetic joint infections: Role of surgery and impact of colistin administration

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