A review of difficult-to-treat post-traumatic osteomyelitis: Role of Clostridium celerecrescens

Abstract

PurposeWe reviewed the clinical features of post-traumatic infections produced by Clostri-dium celerecrescens reported in the literature. C. celerecrescens is an emerging pathogen involved in traumatic wound infection that progresses to deep infection and osteomyelitis. MethodsWe found only 4 cases reported in the literature with enough data to be analysed and we added our own case and experience with this type of infection. The identification was performed by matrix-assisted desorption ionization-time of flight mass spectrometry (MALDI TOF) or API Gallery, and 16S rRNA gene sequencing were performed to confirm identification in all cases. ResultsIdentification of the bacteria is discrepant according to the method used due to the genetic and phenotypic similarities of other species of the genus. Identification through MALDI-TOF and API gallery is not suitable for determining the specie, confirmation by 16S rRNA sequencing being necessary. Treatment of the infection included complex antibiotic combinations and surgical treatment together with skin and soft tissue dressings due to the persistence of the pathogen over time. ConclusionThis report supports the pathogenic role of C. celerecrescens in post-traumatic infections and the need to improve the management of these difficult-to-treat infections.