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Volume 24, Number 10—October 2018
Research Letter

Community-Acquired Staphylococcus argenteus Sequence Type 2250 Bone and Joint Infection, France, 2017

Josselin Rigaill, Florence Grattard, Sylvain Grange, Fabien Forest, Elie Haddad, Anne Carricajo, Anne Tristan, Frederic Laurent, Elisabeth Botelho-NeversComments to Author , and Paul O. Verhoeven
Author affiliations: University Hospital of Saint-Etienne, Saint-Etienne, France (J. Rigaill, F. Grattard, S. Grange, F. Forest, E. Haddad, A. Carricajo, E. Botelho-Nevers, P.O. Verhoeven); Jean Monnet University, Saint-Etienne (J. Rigaill, F. Grattard, A. Carricajo, E. Botelho-Nevers, P.O. Verhoeven); International Centre for Infectiology Research, Lyon, France (A. Tristan, F. Laurent); French National Reference Centre for Staphylococci, Lyon (A.Tristan, F. Laurent)

Main Article


Clinical characteristics and timeline for patient with community-acquired Staphylococcus argenteus sequence type 2250 bone and joint infection, France, 2017*

Jul 30
Aug 2
Aug 8
Sep 5
Nov 2
Hospital Local Tertiary care Tertiary care Tertiary care Tertiary care
Clinical features Pain in third finger of right hand Fever (temperature 38.6°C); pain and functional impotence in flexion of finger Poor tolerance of antimicrobial drugs Fever (temperature 38.4°C); pain in finger Stiffness in finger; no pain
Signs at physical examination Inflammatory edema of finger; no inoculation lesion Phlegmon of finger: inflammatory skin; edema on second phalanx of finger ND Misalignment of second phalanx No signs of infection
Laboratory findings
Leukocyte count, ×109 cells/L† 20 7.2 ND 11.6 7.2
C-reactive protein, mg/L‡ 58 17.7 ND ND 0.3
Microbiological Culture of infection site not performed (no pus); blood culture not performed Examination of surgical samples: neutrophils and gram-positive cocci (identified as S. argenteus); blood cultures sterile ND Examination of surgical samples: few neutrophils and negative gram staining results; culture remained sterile after 10 d; negative 16S rDNA PCR result; blood cultures not performed ND
Radiologic findings Not performed Radiograph of hand: no signs of osteitis ND MRI of hand: osteitis ND
Histologic findings ND Chronic osteitis ND
Diagnosis considered Cellulitis of finger Arthritis of second phalanx and abscess of extensor tendon sheath ND ND
Antimicrobial drugs AMX (1,000 mg/d) and CLA (125 mg/d) CFZ (2,200 mg/d) and GEN (400 mg/d) for 2 d; AMX (2,000 mg/d), CLA (250 mg/d), and RIF (600 mg/d) for 6 wk Stop AMX and CLA; FUS (1.5 g/d) and RIF (600 mg/d) for 5 wk Sep 8: CLI (900 mg/d) and OFX (400 mg/d) for 6 wk ND
Surgery Surgical joint lavage and débridement for massive purulent abscess that reached the extensor tendon and joint capsule of second phalanx; no articular cartilage lesion ND Surgical lavage and realignment of phalanxes with implantation of external fixator on Sep 8 ND
Outcome Discharged Improvement at discharge on Aug 4; patient seen on Aug 6, 8, 10, and 12 Good outcome Discharged on Sep 11; patient seen on Sep 13, 15, and 22, and on Oct 6; external fixator removed on Oct 6 Good outcome and functional rehabilitation; patient seen on Dec 27 and had similar findings

*AMX, amoxicillin; CFZ, cefazolin; CLA, clavulanic acid; CLI, clindamycin; FUS, fusidic acid; GEN, gentamicin; MRI, magnetic resonance imaging; ND, not determined; OFX, ofloxacin; RIF, rifampin.
†Reference range 4.5–13.5 ×109 cells/L.
‡Reference value <5 mg/L.

Main Article

Page created: September 04, 2018
Page updated: September 04, 2018
Page reviewed: September 04, 2018
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