Medicina, Vol. 54 No. 3, 2018.
Ostalo
https://doi.org/10.21860/medflum2018_203553
Treatment of soft tissue infection and osteomyelitis with multi-drug resistant Acinetobacter baumannii following a tibial fracture surgery: case report
Jasenka Škrlin
orcid.org/0000-0001-9486-9695
; Zavod za kliničku mikrobiologiju i bolničke infekcije, Klinička bolnica Dubrava, Zagreb, Hrvatska
Srećko Budi
; Klinika za plastičnu, rekonstrukcijsku i estetsku kirurgiju, Klinička bolnica Dubrava, Zagreb, Hrvatska
Andrea Janeš
orcid.org/0000-0001-7061-6909
; Zavod za kliničku mikrobiologiju i bolničke infekcije, Klinička bolnica Dubrava, Zagreb, Hrvatska
Katarina Dujmović
; Zavod za kliničku mikrobiologiju i bolničke infekcije, Klinička bolnica Dubrava, Zagreb, Hrvatska
Karolina Dobrović
; Zavod za kliničku mikrobiologiju i bolničke infekcije, Klinička bolnica Dubrava, Zagreb, Hrvatska
Sandra Šestan-Crnek
; Zavod za kliničku mikrobiologiju i bolničke infekcije, Klinička bolnica Dubrava, Zagreb, Hrvatska
Sažetak
Aim: The aim was to present surgical and antimicrobial treatment of complicated surgical site infection (SSI) caused by A. baumannii.
Case report: 57-year-old female patient was admitted 3 weeks after plate osteosynthesis for proximal tibial multifragmented fracture. The surgery was performed in another institution. She presented with SSI and osteomyelitis due to A. baumannii. According to microbiology results from another institution, the strain was resistant to carbapenems, fluoroquinolones, aminoglycosides, and to sulbactam and colistin. At presentation she was already being treated with ciprofloxacin and rifampicin but was nevertheless febrile with elevated inflammation markers. New sets of microbiology samples were taken, and the cultures yielded a multi-drug resistant A. baumannii, although sensitive to sulbactam and colistin. In addition to soft tissue necrectomy and sequestrectomy of devitalized bone with subsequent reconstructive surgery, the patient was treated with 14-day long parenteral combination therapy – colistin and fosfomycin. After 23-day-long hospitalization, the patient was transferred to physical rehabilitation clinic in good general health and with satisfactory wound healing.
Conclusion: Acinetobacter baumannii causes less than 3% of SSI-s, and patients with previous traumatic injuries and antibiotic therapy are most at risk. Colistin is preferred therapy for multi-drug resistant A. baumannii. Although A. baumannii is intrinsically resistant to fosfomycin, it is thought that combination therapy with colistin yields synergy. Since fosfomycin is a small molecule, it penetrates biofilm well. Due to extensive surgical and antimicrobial treatment, our patient had a good clinical outcome.
Ključne riječi
Acinetobacter baumannii; colistin; Fosfomycin; surgical site infection
Hrčak ID:
203553
URI
Datum izdavanja:
1.9.2018.
Posjeta: 4.122 *