Enterobacter cloacae in bone and joint infections: analysis of 22 cases from a university referral centre in Greece

Abstract number: R2432

Giannitsioti E., Athanasia S., Papadopoulos A., Plachouras D., Drakou A., Panagopoulos P., Sakka V., Tsiodras S., Koratzanis E., Kanellakopoulou K., Giamarellou H.

Objectives:Enterobacter cloacae is a rare pathogen in bone and joint (BJ) infections. Current study assessed epidemiological and clinical features of 22 patients followed at a referral BJ infection centre in Athens, Greece

Patients and Methods: All cases of bone and joint infections that were clinically, radiologically, laboratory and microbiologically assessed, were retrospectively analysed via an electronic data-base registry. From a total of 574 records, 22 (4%) were microbiologically documented (cultures from pus, intra-operative tissues, bone and foreign material samples) as BJ infections caused by E. cloacae. Treatment success was the clinical, radiological and microbiological resolution of the BJ infection while failure referred to all cases that did not fit this definition. Demographics, surgical operations, antimicrobial treatment, outcome and infection relapses were evaluated.

Results:E. cloacae was isolated from intra-operative bone tissues (n = 5, 23%), pus (n = 15, 68%), synovial fluid (n = 1, 5%) and blood (n = 1, 5%). Mean age of patients was 51.5 years (range 17–76). Men predominated (14/22, 63.6%), as well as comorbidities (i.e diabetes mellitus, cardiovascular disease and rheumatoid arthritis) (13/22, 59%). Almost half of the cases (45.5%) had a history of car accident related to the infection. The time from the infection onset to treatment ranged from 0–24 (mean 5) months. BJ infection was located to joints (n = 4), long bones (n = 17) and lumbar spine (n = 1). Only 3/22 (13.6%) had a medical device (osteosynthesis) while 13/22 (59%) underwent surgical debridement. Ciprofloxacin was administered in 77% of cases at a high dose (1500 to 2000 mg/day) for a mean of 7.3 months (2–16). Treatment success was assessed in 12/22 (54.5%) of cases. There were 2 relapses of the infection during a mean follow-up of 11.2 months (SD + 10.9).

Conclusions: Although rare, E. cloacae is a difficult to treat pathogen in BJ infections, possibly because these infections are often post-traumatic and affect patients with comorbidities. Moreover, despite long and adequate treatment as well as surgical debridement, patients with E. cloacae BJ infections presented with an important rate of failures and relapses of the infection. Good collaboration of orthopaedists and ID specialists on the field is mandatory in order to improve therapeutic approach in these patients.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Location: Barcelona, Spain
Presentation type:
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