Multifocal joint infection caused by Enterococcus gallinarum.

Musculoskeletal infections caused by Enterococcus gallinarum are rare, but due to its multi-drug resistance has gained more and more attention from the scientific community. We report a case of a 81-year-old immunocompetent Caucasian female with a multifocal joint infection caused by this agent. Shoulder arthrocentesis and two different blood cultures were used to identify this vancomycin-resistant agent in a symptomatic patient. After surgical debridement and 8 weeks of antibiotherapy with ampicillin (1000 mg IV every 6 h), the clinical and laboratory findings were all remarkably improved after treatment. After 2 years follow-up, the patient had no recurrence.

Spondylodiscitis: A Retrospective Analysis of Clinical, Etiological, and Radiological Diagnosis.

BACKGROUND: Spondylodiscitis is an uncommon disease, and due to its indolent nature, it is often a late diagnosis. Great stress is put on the etiologic diagnosis, but blood cultures do not always yield positive results. Magnetic resonance imaging (MRI), despite being the diagnostic method of choice, is not always available. Our aim was to characterize the clinical presentation and to identify and check the efficacy of the etiologic and radiological methods of diagnosis of spondylodiscitis used at our hospital. METHODS: A retrospective study was conducted in which spontaneous spondylodiscitis cases were identified. The clinical presentation and the results of etiologic and radiological methods of diagnosis were analyzed. RESULTS: Over a period of 5 years, 34 patients fulfilled the inclusion criteria of the study. Regarding days of complaints, we identified a median of 9.5 days (1-547 days), with back pain being the predominant symptom. Fever was present in half the patients. Blood cultures were positive in 16 patients (48.5%). Nineteen patients underwent a computed tomography (CT)-guided biopsy (positive in 7 patients [36.8%]), and 10 patients underwent a surgical biopsy (positive in half of them). Overall, 27 patients (79.4%) had an etiologic diagnosis. The diagnostic work-up consisted mostly of an initial CT scan followed by a confirmatory MRI. Of note, in 5 patients the CT scan did not reveal changes that were later confirmed by MRI. A total of 29 patients (85.3%) underwent an MRI, with 28 being diagnostic. CONCLUSIONS: Spondylodiscitis remain a difficult diagnosis. Blood cultures should always be obtained before antibiotic administration and a CT-guided or surgical biopsy should be done if needed. Our results confirm the importance of MRI as the imaging modality of choice and highlight the possibility of false-negative CT scans and the inability of CT to allow for a definitive diagnosis.