Spinal infection caused by ESBL-producing Klebsiella pneumoniae treated with Temocillin

Barton, Edward; Flanagan, Paul; Hill, S

doi:10.1016/j.jinf.2008.08.001

Cited by 16 publications

(9 citation statements)

References 8 publications

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“…The most common physical signs are localized tenderness over the affected area, with concomitant paraspinal muscle spasm, as described in the only other previous reported case of G. vaginalis spinal infection (Hodge et al, 1995). The most consistent laboratory abnormalities seen are an elevated erythrocyte sedimentation rate and CRP level, but these were only minimally raised in this case (Barton et al, 2008). Positive blood cultures are seen in approximately one-half of cases, and so diagnosis must be made by aspiration and culture of disc fluid.…”

Section: Discussionsupporting

confidence: 59%

Vertebral osteomyelitis and discitis due to Gardnerella vaginalis

Graham

Howes

Dunsmuir

et al. 2009

Journal of Medical Microbiology

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Gardnerella vaginalis is a facultative anaerobic Gram-variable pleomorphic rod that forms part of the normal vaginal flora. It is most commonly associated with infection of the genital tract in women, but recognition of extravaginal G. vaginalis infection is becoming more frequent. We describe an unusual case of G. vaginalis vertebral osteomyelitis and discitis in a 38-year-old woman with no apparent predisposing factors. Case reportA 38-year-old pre-menopausal woman presented to the Accident and Emergency Department, Leeds General Infirmary Teaching Hospitals, Leeds, with a 5-day history of an increasingly severe frontal headache. Lumbar puncture and a computed tomography scan of her head were normal, and the patient was sent home with analgesic medication and advice to visit her general practitioner if symptoms persisted. The following day the patient represented to the Accident and Emergency Department with additional symptoms of photophobia and vomiting in combination with persistence of the original headache. She denied any history of fever, rigors, back pain, back surgery, trauma, infection (including urinary), recent gynaecological procedures, use of antimicrobials or use of illicit drugs. She had no significant past medical history, and two normal vaginal births, the last of which was 10 years ago.Physical examination of her respiratory, cardiac and abdominal systems revealed no abnormalities. Neurological and cranial nerve examination results were completely normal. There was some tenderness in the lumbosacral region and restriction in forward flexion of the lumbar spine.She had a peripheral white blood cell count of 7.01610 9 cells l 21 , a haemoglobin level of 12.9 g dl 21 and a platelet count of 2.19610 11 platelets l 21 . Her C-reactive protein (CRP) level was 6.1 mg l 21 and her renal function was normal. Urine analysis was unremarkable. Magnetic resonance imaging (MRI) of the spine (Fig. 1) revealed early signs of vertebral osteomyelitis and discitis at the level of L2/L3 vertebrae. A small epidural fluid collection at L2/L3, which showed marked rim enhancement with a small amount of fluid centrally, was effacing the lateral recess and was directly impinging upon the traversing left L3 as well as the exiting L2 nerve roots.The patient was placed on bed rest, and blood and urine cultures were collected. A computed-tomography-guided biopsy of L2/L3 was performed, the biopsy specimen was sent for microbiological examination (but not histopathological examination) and empirical antimicrobial therapy (2 g flucloxacillin every 6 h intravenously) was started. Microscopy was performed on the small volume biopsy sample but showed no white blood cells or organisms. The biopsy was cultured aerobically [CLED (cystine lactose electrolyte deficient) agar, Sabaroud agar], anaerobically (fastidious anaerobe agar with and without neomycin, fastidious anaerobe broth) and in 5 % CO 2 (blood and chocolate agar) for 5 days (all media were supplied by E&O Laboratories). Mycobacterial culture was also set up using an au...

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Section: Discussionsupporting

confidence: 59%

Vertebral osteomyelitis and discitis due to Gardnerella vaginalis

Graham

Howes

Dunsmuir

et al. 2009

Journal of Medical Microbiology

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“…There was a report where after a complex gastrointestinal surgery developed cervical epidural abscess. [27] 2.5% of CNS infections have been attributed to Klebsiella pnumoniae. [28] In this report series, Klebsiella pneumonia infection developed de novo post operative without gastrourinary trauma/associated infection per se thus was worth reporting.…”

Section: Discussionmentioning

confidence: 99%

Does Spondylodiscitis Follow All Its Parameters? - Report of Three Atypical Cases

Roy¹

2017

jmscr

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Vertebral osteomyelitis or spondylodiscitis is 2-7% of osteomyelitis. Iatrogenic spondylodiscitis accounts for 1-11%. Common organism is Staphylococcus aureus and usually the mean time from onset of symptoms to diagnosis has been reported to range from 8 weeks to 3 months. Worsening back pain with reduced spinal ROM is sine qua non on iatrogenic spondylodiscitis. CRP and ESR are most important prognostic factors of treatment. In this report I present three cases one which started florid infections and its signs and symptoms much later than documented times after operation, one who developed post procedural discitis by an atypical bacteria without any definite cause of it to do it, one with indolent tunneling infection of the vertebral body after minimally invasive discectomy without any considerable alteration in clinicalfunctioning but with alteration radiologically and biochemically.

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“…23 There have been several case reports of difficult-to-treat osteomyelitis caused by multiresistant gram-negative bacteria, each with unique treatment failures and successes. 2,11 One case of refractory vertebral osteomyelitis has been described due to an extended spectrum b-lactamase (ESBL)-producing Escherichia coli with an apparent treatment failure to ertapenem despite a susceptible MIC on E-testing (0.5 mg/ L). 11 In this case the authors describe multiple patient factors (e.g., peripheral vascular disease, bone necrosis) that contributed to therapeutic failure, in addition to suboptimal local antibiotic concentrations.…”

Section: Discussionmentioning

confidence: 99%

“…A case of cervical discitis caused by an ESBL-producing Klebsiella pneumoniae successfully treated with IV temocillin has also been reported. 2 Unfortunately, both the antibiotic and susceptibility testing for temocillin are unavailable in Australia.…”

Section: Discussionmentioning

confidence: 99%