Volume 24, Number 10—October 2018
Research Letter
Community-Acquired Staphylococcus argenteus Sequence Type 2250 Bone and Joint Infection, France, 2017
Josselin Rigaill, Florence Grattard, Sylvain Grange, Fabien Forest, Elie Haddad, Anne Carricajo, Anne Tristan, Frederic Laurent, Elisabeth Botelho-Nevers
, and Paul O. Verhoeven
, and Paul O. Verhoeven
Table
Clinical characteristics and timeline for patient with community-acquired Staphylococcus argenteus sequence type 2250 bone and joint infection, France, 2017*
| Characteristic |
Jul 30 |
Aug 2 |
Aug 8 |
Sep 5 |
Nov 2 |
| Hospital | Local | Tertiary care | Tertiary care | Tertiary care | Tertiary care |
| Clinical features | Pain in third finger of right hand | Fever (temperature 38.6°C); pain and functional impotence in flexion of finger | Poor tolerance of antimicrobial drugs | Fever (temperature 38.4°C); pain in finger | Stiffness in finger; no pain |
| Signs at physical examination | Inflammatory edema of finger; no inoculation lesion | Phlegmon of finger: inflammatory skin; edema on second phalanx of finger | ND | Misalignment of second phalanx | No signs of infection |
| Laboratory findings | |||||
| Leukocyte count, ×109 cells/L† | 20 | 7.2 | ND | 11.6 | 7.2 |
| C-reactive protein, mg/L‡ | 58 | 17.7 | ND | ND | 0.3 |
| Microbiological | Culture of infection site not performed (no pus); blood culture not performed | Examination of surgical samples: neutrophils and gram-positive cocci (identified as S. argenteus); blood cultures sterile | ND | Examination of surgical samples: few neutrophils and negative gram staining results; culture remained sterile after 10 d; negative 16S rDNA PCR result; blood cultures not performed | ND |
| Radiologic findings | Not performed | Radiograph of hand: no signs of osteitis | ND | MRI of hand: osteitis | ND |
| Histologic findings | ND | Chronic osteitis | ND | ||
| Diagnosis considered | Cellulitis of finger | Arthritis of second phalanx and abscess of extensor tendon sheath | ND | ND | |
| Treatment | |||||
| Antimicrobial drugs | AMX (1,000 mg/d) and CLA (125 mg/d) | CFZ (2,200 mg/d) and GEN (400 mg/d) for 2 d; AMX (2,000 mg/d), CLA (250 mg/d), and RIF (600 mg/d) for 6 wk | Stop AMX and CLA; FUS (1.5 g/d) and RIF (600 mg/d) for 5 wk | Sep 8: CLI (900 mg/d) and OFX (400 mg/d) for 6 wk | ND |
| Surgery | Surgical joint lavage and débridement for massive purulent abscess that reached the extensor tendon and joint capsule of second phalanx; no articular cartilage lesion | ND | Surgical lavage and realignment of phalanxes with implantation of external fixator on Sep 8 | ND | |
| Outcome | Discharged | Improvement at discharge on Aug 4; patient seen on Aug 6, 8, 10, and 12 | Good outcome | Discharged on Sep 11; patient seen on Sep 13, 15, and 22, and on Oct 6; external fixator removed on Oct 6 | Good outcome and functional rehabilitation; patient seen on Dec 27 and had similar findings |
*AMX, amoxicillin; CFZ, cefazolin; CLA, clavulanic acid; CLI, clindamycin; FUS, fusidic acid; GEN, gentamicin; MRI, magnetic resonance imaging; ND, not determined; OFX, ofloxacin; RIF, rifampin.
†Reference range 4.5–13.5 ×109 cells/L.
‡Reference value <5 mg/L.
Page created: September 04, 2018
Page updated: September 04, 2018
Page reviewed: September 04, 2018
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