Methicillin-resistant Staphylococcus epidermidis knee prosthetic infection treatment with two-stage revision and fosfomycin-rifampin combination therapy: a case report.
Giulio Maria Marcheggiani Muccioli, Eleonora Zamparini, Alberto Fogacci, Andrea Grechi, Federico Pea, Pierluigi Viale, Stefano Zaffagnini
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引用次数: 0
Abstract
Background: Staphylococcus epidermidis is one of the pathogens most commonly involved in prosthetic joint infections, and when methicillin resistant, poses significant challenges in treatment, owing to its virulence and antibiotic resistance. Intravenous fosfomycin disodium is a broad-spectrum antibiotic recently introduced in clinical practice for treating osteoarticular infections caused by Gram-negative and Gram-positive bacteria, including multidrug-resistant pathogens. Continuous infusion administration of fosfomycin, by an elastomeric pump, is feasible thanks to its good stability at room temperature after reconstitution in aqueous solution. This report describes the case of a methicillin-resistant Staphylococcus epidermidis knee prosthetic infection successfully treated with a two-stage revision coupled with a combination therapy of oral rifampin plus continuous infusion of fosfomycin administrated by an elastomeric pump, filled daily through an outpatient parenteral antimicrobial treatment service.
Case presentation: A 31-year-old Italian woman presented right knee pain and functional limitation. A previous diagnosis of pigmentous villonodular synovitis led to destructive arthropathy requiring total knee arthroplasty and extensive synovectomy. Three months later, a methicillin-resistant Staphylococcus epidermidis prosthetic infection was diagnosed and a two-stage procedure was adopted with spacer cement positioning for 4 months, followed by removal and definitive total knee arthroplasty. The methicillin-resistant Staphylococcus epidermidis infection was successfully treated with a combination therapy of oral rifampin plus continuous infusion fosfomycin by an elastomeric pump. At 1-year postoperative follow-up, no complication was detected and the patient was satisfied.
Conclusion: This case underscores the effectiveness of combining a two-stage revision procedure with continuous infusion fosfomycin and rifampin for managing complex methicillin-resistant Staphylococcus epidermidis prosthetic infection.
期刊介绍:
JMCR is an open access, peer-reviewed online journal that will consider any original case report that expands the field of general medical knowledge. Reports should show one of the following: 1. Unreported or unusual side effects or adverse interactions involving medications 2. Unexpected or unusual presentations of a disease 3. New associations or variations in disease processes 4. Presentations, diagnoses and/or management of new and emerging diseases 5. An unexpected association between diseases or symptoms 6. An unexpected event in the course of observing or treating a patient 7. Findings that shed new light on the possible pathogenesis of a disease or an adverse effect