Case series of carbapenemase-producing Enterobacteriaceae osteomyelitis: Feel it in your bones

Area of Science:

• Infectious Diseases
• Orthopedics
• Microbiology

Background:

• Osteomyelitis caused by carbapenemase-producing Enterobacteriaceae (CPE) is rare, with limited reported data.
• Co-infections with extended-spectrum β-lactamase (ESBL)-producing microorganisms are common in these cases.

Purpose of the Study:

• To investigate the characteristics and outcomes of osteomyelitis caused by CPE.
• To identify key factors for successful infection control in CPE osteomyelitis.

Main Methods:

• Retrospective study conducted between 2011 and 2019.
• Inclusion of patients diagnosed with CPE infections at a reference center for bone and joint infections.
• Analysis of patient demographics, infection characteristics, causative agents, and treatment outcomes.

Main Results:

• Nine patients with CPE osteomyelitis were identified, three with infected implants.
• Infections were predominantly polymicrobial, frequently involving Staphylococcus aureus.
• OXA-48-type CPE were common, often associated with ESBL-producing Enterobacteriaceae, including Klebsiella pneumoniae.
• Infection control was achieved in seven out of nine patients.

Conclusions:

• CPE osteomyelitis is typically a polymicrobial infection.
• Fluoroquinolone resistance is a significant challenge in managing these infections.
• Surgical intervention, including implant removal when necessary, is crucial for successful treatment.