engleski

Pubic symphysis septic arthritis and osteomyelitis associated with abscess caused by Staphylococcus aureus

Objectives: Dalbavancin is a novel lipoglycopeptide with a long half-life approved for the treatment of acute bacterial skin and skin structure infections and has a sufficiently promising pharmacokinetic and pharmacodynamic profile to be considered for the treatment of osteomyelitis. Methods: We present a patient with pubic septic arthritis and osteomyelitis with abscess caused by Staphylococcus aureus (MSSA) Results: A 72-year-old female patient, with type 2 diabetes as the only comorbidity, was admitted to the University Hospital for Infectious diseases (UHID), Zagreb, Croatia with a one-month history of progressive suprapubic pain with fatigue and subfebrile temperature. Due to the isolated sensitive Klebsiella pneumoniae from the urine sample and suspected urinary tract infection, the peroral therapy with ciprofloxacin 500 mg BID for 9 days, followed by three days of parenteral gentamicin was applied until admission, both with unfavourable clinical response. At admission the patient had normal vital parameters, barely lifting the legs from the floor, and beside skin edema and pain in the pubic region other clinical status was normal. Erythrocyte sedimentation rate (ESR) was 80 mm/1hour, C-reactive protein (CRP) 172.4 mg/L, leukocyte (L) 10.7 x109/L while other routine blood and urine laboratory tests revealed normal results. Cellulitis and osteomyelitis of the pubic region was suspected and empirical intravenous therapy with clindamycin 900 mg TID was started. S. aureus (MSSA) was isolated from blood culture (penicillin resistant, methicillin and clindamycin sensitive). Magnetic resonance imaging (MRI) revealed centrally necrotic abscess affecting the pubic bone bilaterally and the joint space. Soft tissue and surrounding bone oedema was also seen. Posteriorly, the process abutted/affected the retroperitoneal fat. After 11 days of slow response to clindamycin, the therapy was continued with dalbavancin. The patient received two doses of dalbavancin, each of the 1500 mg applied intravenously at 8-days interval, without significant adverse effects. A few days after the last dose of dalbavancin, 22 days after admission, the patient was discharged from UHID. At the first follow up visit three weeks later, the patient had complete resolution of symptoms, and normalization of all disturbed laboratory findings (ESR 36 mm/1.hours, CRP 3.4 mg/L, L 6.1×109/L). Conclusion: Two 1500 mg intravenous doses, applied 8 days apart, make dalbavancin a valuable option for treating MSSA osteomyelitis and soft tissue abscess.

Staphylococcus aureus

nije evidentirano