Reactions 1680, p265 - 2 Dec 2017 Emergence of antibiotic resistance in Staphylococcus lugdunensis: case report A woman in her 70’s developed antibiotic resistance in Staphylococcus lugdunensis following therapy with ofloxacin and rifampicin [routes, dosages and time to reaction onset not stated]. The 70-year-old woman, who was admitted to the orthopaedic department in May 2012, had a history of total knee arthroplasty for degenerative arthritis. However, this prosthesis was changed in 2010 due to multidrug-resistant Staphylococcus epidermidis prosthetic infection, which was successfully treated with rifampicin and daptomycin following surgery. During the current presentation, she developed a sudden pain in the right knee during exercise and two weeks later, a swelling of the knee was observed. Fluid joint aspiration demonstrated pus, and S. lugdunensis was found on culture. Based on MALDI-TOF MS and antimicrobial susceptibility, she was treated with prosthesis retention, debridement and exchange of the poly-ethylene liner associated with antibiotic therapy including rifampicin and ofloxacin. The antibiotic treatment was initially successful but she developed mechanical joint pain three months post antibiotic therapy discontinuation, which slowly worsened until October 2013. Preoperative synovial fluid aspiration was taken and a one-stage exchange of the prosthesis was performed with the prescription of an empirical antibiotic therapy. Several samples were analysed by periprosthetic biopsies, synovial tissue cultures and sonication of the removed material inoculated in paediatric blood culture. All samples sub-cultured on sheep blood agar solid media demonstrated a small colony variant of S. lugdunensis. Antimicrobial susceptibility testing revealed that the strain was resistant to fluoroquinolones. The strain had become antibiotic resistant. The woman received treatment with rifampicin and fusidic acid for three months. Subsequently, she fully recovered at one year follow-up. Author comment: "We report a case of S. lugdunensis prosthetic knee infection that relapsed one year later with the same strain that changed from regular to small colony variant and became antibiotic-resistant." "Our case report revealed that S. lugdunensis infection persisted despite initial antibiotic treatment, and SCV (small colony variant) conversion could have occurred because of inherent characteristics of the bacterium and because of exposure to quinolones or rifampicin". Argemi X, et al. Staphylococcus lugdunensis small colony variant conversion resulting in chronic prosthetic joint infection. Medecine et Maladies Infectieuses 47: 498-501, No. 7, Nov 2017. Available from: URL: http://doi.org/10.1016/ j.medmal.2017.05.005 - France 803285414 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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