Antoine Ouziel (France)
Hospices Civils de Lyon - Hopital Femme Mere Enfant Service de Reanimation et Urgences PediatriquesAuthor Of 1 Presentation
AN UNCONTROLLED AND DISSEMINATED BONE INFECTION
Abstract
Title of Case(s):
An uncontrolled and disseminated bone infection
Background:
Salmonella typhimurium is the most common serotype of Salmonella identified in western countries (23,4%). Disease mainly expresses by gastroenteritis syndrome but sometimes can show characteristics of invasive infection (5.7%). Risk factors for invasive infection are well known: HIV, malaria coinfection, malnutrition, and sickle cell disease.
Case Presentation Summary:
We present the case of a 2 years-old boy with sickle cell disease coming back from Senegal, consulting at our paediatric hospital in Lyon after 6 days of limping with fever, with an initial clinical presentation of septic shock. Cultures were positives for Salmonella typhimurium in stools, blood cultures, bone biopsy specimen and cerebrospinal fluid. He was treated empirically with CLAFORAN and 3 days of AMIKACINE then with CLAFORAN and CIPROFLOXACINE. Despite a multi sensible bacteria, usual doses of combination antibiotic therapy for osteomyelitis, drainage of an abscess of the right-side femur, and negative blood cultures, he was still febrile and painful at 4 weeks from the start of management. We repeated radiologic staging for uncontrolled osteomyelitis, with radiographies, ultra-sound, scintigraphy, and MRI. Finally, a total body MRI at day 27 showed a multifocal osteomyelitis with disseminated localisation: skull, rachis, ribs, sternum, and the four limbs. He underwent a surgery to control the source of infection, with irrigation and drainage of all abscesses over 2 cm, and of all the diaphysis of long bones of the 4 limbs. At day 35 we decided to optimize the pharmacokinetic-pharmacodynamic with continuous intravenous Beta-lactam antibiotic, as CEFOTAXIME residual level was under the minimum inhibitory concentrations. Clinical and biological outcomes were finally favourable at 3 months after the surgery, allowing us to stop the antibiotic therapy.
Key Learning Points:
Salmonella typhimurium can sometimes present with invasive and disseminated infection especially in sickle cell patients. Source control and optimization of pharmacokinetic-pharmacodynamics parameters are essentials in bone infection.