OSTEODISCITIS DUE TO MYCOBACTERIUM TUBERCULOSIS, IN A PATIENT WITH MILIARY TUBERCULOSIS, LEFT NEPHRECTOMY AND POST-OPERATIVE WOUNDS INFECTED WITH MULTI-DRUG RESISTANT BACTERIA

Abstract

Background. Severe immunosuppression caused by various types of surgical procedures, such as ureteral catheterization, can increase the risk of tuberculosis (TB) reactivation and can be involved in the appereance of disseminated TB (1). Pseudomonas aeruginosa is the third most common organism, after Escherichia coli and Proteus mirabilis, isolated from patients with urinary tract infections in the hospital setting. Despite the progress made in the research field of antibiotics, mortality and morbidity associated with this etiology are still increased (2). Miliary TB is a form of disseminated TB that can be fatal in the absence of an early diagnosis and treatment. This form of disease mainly affects young immunosuppressed patients, and has a higher prevalence in women (1,3). Materials and methods. We present the case of a 25 year-old female, who was admitted at Victor Babes Clinical Hospital for Infectious and Tropical Diseases for a postdiscectomy tuberculous spondylodiscitis (T11- T12). The hospital admission was for two reasons: to treat the post surgery wounds super infected with methicilin-resistant Staphylococcus aureus and Pseudomonas aeruginosa and secondly, to obtain a bacteriological confirmation for the tuberculous spondylodiscitis (at T11-T12) in order to start an anti-tuberculous drug regimen. Results. After the diagnosis and treatment initiation with meropenem, colistin, vancomycin and anti-tuberculous drugs the outcome of the patient was favorable. The clinical, bacteriological and radiological parameters normalized after one month of therapy. Conclusions. When a infection is bacteriologically confirmed, early antibiotic susceptibility testing and treatment are essential for the prevention of serious local and systemic complications associated with surgical procedures.

Keywords

• tuberculous osteodiscitis
• miliary tuberculosis
• nephrectomy
• post-operative wounds
• superinfected
• multi-drug resistant
• pseudomonas aeruginosa
• methicilin-resistant staphylococcus aureus (mrsa)