Invasive pectoral abscess and costal osteomyelitis with bloodstream infection caused by methicillin-resistant Staphylococcus aureus after nasal septoplasty in an immunocompetent adult patient |
| |
| Affiliation: | 1. Department of General Internal Medicine and Infectious Diseases, National Hospital Organization, Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan;2. Department of Microbiology and Infectious Diseases, Faculty of Medicine, Toho University, 5-21-16, Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan;1. Department of Infectious Diseases, St. Luke''s International Hospital: 9-1, Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan;2. Graduate School of Public Health, St. Luke''s International University: OMURA Susumu & Mieko Memorial St. Luke''s Center for Clinical Academia, 5th Floor, 3-6-2, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan;1. Department of Infectious Diseases, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan;2. Department of Clinical Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan;3. Department of Microbiology, Faculty of Pharmacy, Meijo University, Aichi, Japan;4. Department of Diabetology, Endocrinology and Metabolism, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan;1. The University of Tokyo Hospital, Department of Infectious Diseases, Tokyo, Japan;2. Tokyo Metropolitan Institute of Public Health, Tokyo, Japan;1. Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, 54 Shogoin- Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan;2. Department of Infection Control and Prevention, Kyoto University Hospital, 54 Shogoin- Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan;3. Department of Clinical Laboratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan;4. Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan;1. Department of Pharmacy, Kitasato University Hospital, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0375, Japan;2. Pharmacy Practice and Science I, Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0375, Japan;3. Department of Infection Control and Infectious Diseases, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0375, Japan;4. Department of Pharmacy, Tokyo Medical And Dental University Hospita, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan;5. Laboratory of Clinical Pharmacokinetics, Research and Education Center for Clinical Pharmacy, Kitasato University School of Pharmacy, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0375, Japan;6. Department of Colorectal Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0375, Japan;7. First Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan;8. Departments of Pharmacology and Anesthesiology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0375, Japan;9. Infection Control Research Center, Kitasato Institute for Life Sciences, Kitasato University, 5-9-1 Shirogane, Minato-ku, Tokyo, 108-8641, Japan |
| |
| Abstract: | There are few reports of multilocus sequence type (ST) 5/staphylococcal cassette chromosome (SCC) mec type IVc/toxic shock syndrome toxin (TSST)-1- positive methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections.We report a case of community-onset MRSA (CO-MRSA) bloodstream infection in a healthy 41-year-old Japanese man after nasal septoplasty, followed by pectoral abscess and costal osteomyelitis. The patient presented with right anterior chest pain and fever. After admission, MRSA was isolated from two sets of blood cultures, and vancomycin was administered. On the fifth day, contrast-enhanced computed tomography (CT) scan and contrast-enhanced magnetic resonance imaging (MRI) scan showed an abscess in the right anterior chest to the right subpleural region. The dosage of vancomycin (4 g/day) did not reach the effective blood concentration; therefore, there was a switch to daptomycin. On the 23rd day, contrast-enhanced MRI revealed osteomyelitis of the right first rib, and as a result, linezolid was initiated. Two weeks later, contrast-enhanced CT of the chest showed improvement in the abscess. The patient was treated for 6 weeks during hospitalization and then switched to minocycline for 10 weeks.Molecular characterization of this isolate showed that it was ST5/SCCmec type IVc/TSST-1-positive/Panton-Valentine leucocidin (PVL)-negative.PVL-negative CO-MRSA can lead to hematogenous osteomyelitis and abscess even if the patient is immunocompetent, and if isolated from blood cultures, it is important to repeat imaging studies, even if the initial imaging studies were normal. It is possible that this strain contributes to the pathogenesis of invasive CO-MRSA, but further case accumulation is needed. |
| |
| Keywords: | Community-onset MRSA Pectoral abscess Osteomyelitis Immunocompetent adult Bloodstream infection Toxic shock syndrome toxin |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
