INTRODUCTIONKlebsiella pneumoniae septic arthritis and osteomyelitis, albeit uncommon in adults, are important sites of disseminated infection. Many case reports have shown K. pneumoniae as a cause of nosocomial transmitted septic arthritis in neonates and children. We report a rare case of an elderly patient with K. pneumoniae genitourinary infection spreading to the liver and other extra hepatic sites like the prostate and peripheral joint.

CLINICAL PICTUREThe patient presented with a short history of general malaise, fever and urinary symptoms, associated with an acute monoarthritis of the ankle. On admission, he was in septic shock. Investigations suggested an infective cause, as evidenced by raised total white cell count and pyuria. K. pneumoniae was cultured from both urine and ankle synovial fluid. Imaging confirmed multiple liver and prostatic abscesses, as well as osteomyelitis of the foot bones adjacent to the ankle.

TREATMENTTreatment in this case included surgical drainage of the affected joint and surrounding soft tissue structures, in addition to a 6-week course of systemic antibiotics.

OUTCOMEThe patient had good clinical response following treatment. In addition, we noted a normalisation of his laboratory parameters and resolution of the intraabdominal and pelvic abscesses.

CONCLUSIONThis case emphasises the importance of timely and accurate diagnosis followed by appropriate treatment in disseminated K. pneumoniae infection to prevent significant morbidity and mortality.

Aged ; Ankle Joint ; microbiology ; surgery ; Anti-Bacterial Agents ; therapeutic use ; Arthritis, Infectious ; diagnosis ; microbiology ; therapy ; Combined Modality Therapy ; Drainage ; Foot Bones ; microbiology ; Humans ; Klebsiella Infections ; diagnosis ; therapy ; Klebsiella pneumoniae ; Liver Abscess ; microbiology ; Magnetic Resonance Imaging ; Male ; Osteomyelitis ; drug therapy ; epidemiology ; microbiology ; surgery ; Prostatic Diseases ; microbiology ; Synovial Fluid ; microbiology ; Tomography, X-Ray Computed ; Urinary Tract Infections ; drug therapy ; microbiology

BACKGROUND: To analyze the incidence and clinical-microbiological characteristics of osteomyelitis (OM) in a tertiary Spanish hospital. METHODS: All cases diagnosed with OM between January 2007 and December 2010 were retrospectively reviewed. The variables examined include epidemiological characteristics, risk factors, affected bone, radiographic changes, histology, microbiological culture results, antibiotic treatment, and the need for surgery. RESULTS: Sixty-three cases of OM were diagnosed. Twenty-six patients (41.3%) had acute OM whereas 37 patients (58.7%) were classified as chronic OM. OM may result from haematogenous or contiguous microbial seeding. In this group, 49 patients (77.8%) presented with OM secondary to a contiguous source of infection and 14 patients had hematogenous OM (22.2%). Staphylococcus aureus was the most commonly found microorganism. CONCLUSIONS: OM mainly affected patients with risk factors related to the presence of vascular diseases. Antibiotic treatment must be guided by susceptibility patterns of individual microorganisms, although it must be performed together with surgery in most of the cases.
Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Child ; Child, Preschool ; Chronic Disease ; Female ; Humans ; Infant ; Male ; Middle Aged ; *Osteomyelitis/drug therapy/epidemiology/microbiology ; Retrospective Studies ; Risk Factors ; Spain/epidemiology ; Staphylococcal Infections ; Staphylococcus aureus/isolation & purification ; Tertiary Care Centers ; Young Adult