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Bacillus cereus in orthopaedic and traumatology wards. An unrecognised pathogen? A 63-case study

Abstract number: 902_p1426

Bonnet E.

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Objectives:

To describe epidemiological circumstances and clinical signs associated with B. cereus isolation, to state its pathogenic role in post-traumatic infections and to propose guidelines for treatment and prevention.

Methods:

We conducted a retrospective 6-year study (1997–2002) based on all B. cereus isolations from patients in the orthopaedic traumatologic units in Toulouse University Hospitals (Southern France). The patients selected in this study were those presenting clinical signs compatible with joint, bone or soft-tissue infection including fever, local inflammation, purulent discharges, wound dehiscence, necrosis. We collected data on the types of accident. B. cereus was isolated from local samples, taken in the operative room, from wounds, open fractures or operative sites.

Results:

Sixty-three patients were included in the study (47 male and 16 female). The average age was 42 years (16–82). The distribution of cases over the study period was homogenous. All patients were victims of accidents (road accidents: 63%, industrial or agricultural accidents: 30%, sport accidents: 7%). Patients (89%) had an open fracture. Almost two-thirds of the patients presented fever at the time of B. cereus isolation but none presented severe sepsis. Culture were polymicrobial in 44% of the cases. E. cloacae was the most frequently associated bacterium. Before isolation of B. cereus all the patients but three had received antibiotics [amoxiclav: 78% (with aminoglycoside: 22%)]. All the strains were resistant to penicillin, amoxiclav and cephalosporins, but susceptible to quinolones, aminoglycosides, macrolides, clindamycin, pristinamycin and imipenem. Treatment included a fluoroquinolone in 89% of the cases and miscellaneous in vitro active agents in the other cases. The healing of the wounds was obtained in 86% of the cases. Seven patients (two of them not treated by antibiotics) had to be amputated despite aggressive surgical treatment.

Conclusion:

The role of B. cereus should not be underestimated in patients with clinical signs of infection after injuries soiled by tellurian environment. Quinolones could be proposed as the first choice for antibioprophylaxis or curative treatment of those infections.

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Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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