Abstract
After rifampin and levofloxacin treatment for a Staphylococcus aureus bone infection, a pyogenic granuloma due to a newly described Cutibacterium species, C. namnetense developed on the tibia former external fixator. This rifampin resistant bacterium, selected during treatment, harbored a mutation in the rpoB gene. This case illustrates the possible in vivo selection of resistant mutant most likely due to the bacterial burden and therefore the importance of adequate bone infection treatment.
Highlights
Staphylococcus aureus persists as a leading cause of bone or implant-associated infections [1]
The aim of this study was to report the first Cutibacterium namnetense infection and how this new pathogenic Cutibacterium species from the skin microbiota emerged after a S. aureus infection treatment
Namnetense high inoculum during this infection (four out of five samples were positive in culture in four days with numerous colonies, leading to a tibia pandiaphysitis linked to the former external fixator, (ii) the levofloxacin MIC (0.25 mg/L) that might be less protective than moxifloxacin (MIC= 0.06 mg/L) for rifampin mutant selection, (iii) the high-mutation frequency induced by rifampin [9], highlighting the reason why rifampin should not be prescribed alone [2]
Summary
Staphylococcus aureus persists as a leading cause of bone or implant-associated infections [1]. The aim of this study was to report the first Cutibacterium namnetense infection and how this new pathogenic Cutibacterium species from the skin microbiota emerged after a S. aureus infection treatment. The second stage of surgery relied on consolidation of the tibia using an intramedullary rod during which five tissue samples were collected and antibiotic therapy was started using vancomycin (2g/day) and http://www.jbji.net gentamicin (200 mg/day).
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