On line appendix Table : Chronologic summerized presentation of the main clinical, biological and outcome datas of the 14 cases of PVL-positive BJI.
Patient/
Gender/
Age/
Type of infection
/
Localisation/
Initial lesions
Delay for
first
examination
Remarkable initial features
Case 1
M
13y2m
Osteomyelitis/
Left tibia/
Superficial wound
72 h
Fever>39°C
Septic shock
Case 2
M
8y
Arthritis
Right knee
Superficial wound
24 h
Case 3
F
14m
Arthritis
Left hip
None
Case 4
M
14y
Case 5
M
14y10m
Initials
WBC (x
109/L)
CRP
(mg/L)
Antibiotics
duration
(m=month)
Positive culture
Febrile days /
Hospital days
Musculo- skeletal
imaging
Outcome: remarkable events
WBC=5.8
109 days IV and
Per oral: 12 m
Blood cultures,
Articular and abscess
samples (2)
21 days /
2 months
X Rays
Echography
TDM
Osteomyelitis, sub periosteal abscess, necrotizing
fasciitis with abscess
Renal failure, hepatitis, emphysema and abscess of the
lung, intestinal obstruction
1 m IV
Per oral: 6 m
Blood culture
Articular puncture (1)
26days /
90days
X Rays
MRI
Scintigraphy
3 m IV
Per oral: 3 m
Blood culture
Articular puncture (1)
60 days /
nd
X Rays
TDM
2 m IV
Per oral : 6 m
Blood culture
Articular puncture (1)
X Rays
MRI
2m IV
Per oral: 4 m
Blood culture
Abscess sample (1)
22 days /
43 days + 30
days of homecare
2 months /
2 months
Periosteal abscess, osteomyelitis of the whole femur
Lung abscess, kidney abscess, hepatitis
Femoral fracture
Leg length discrepancy
Femoral shaft osteomyelitis
Sub periosteal abscess
Gram-negative infection of the surgical wound
Bone sequestrum
Proximal humeral ostéomyelitis, peri articular soft
tissues abscess, elbow arthritis
Lung abscess
X Rays
4 TDM
2 MRI
Osteomyelitis and arthritis of the hip
Relapsed ilio-pubial abscess
Thrombosis of the right iliac venous
Pelvic abscess
49 days IV
Per oral: 3 weeks
Blood cultures
14 days/
28 days
Proximal tibia osteomyelitis, sub periosteal abscess
Necrotizing fasciitis
Thrombosis of the popliteal venous
128 days IV
Per oral: 6 m
Immunoglobulin
(6 injections)
Blood cultures
Articular puncture (1)
41days/
60days
X Rays
2 MRI
3 TDM
1 Scintigraphy
X Rays
TDM
2 MRI
Scintigraphy 18
months later
Surgical procedures* / Delay
for surgery (days)/
Gene
mecA
Followup
(months)
Number of procedure (surg)
CRP=233
Drainages of sub periosteal
abscess(8d), knee joint (12d),
fasciotomy (15d)
Enterotomy (10d)
Total: 4 surg(+ 2 samples =6)
Surgical drainages of 2
abscess (10d / 29d)
Total: 2 surg (+1 sample =3)
-
54
-
12
Arthrotomy (3d), drainage of
sub periosteal abscess (28d)
Bone sequestrectomy (90d)
Total: 3 surg (+1sample = 4)
Drainages of soft tissues
abscess(11d), shoulder
joint(17d), elbow joint(18d)
Total: 3 surg (+1sample=4)
Ilio-pubial abscess drainage
(1d) Repeated drainages of
ilio-pubial abscess (4)
(5d/9d/26d/32d)
Total: 5 surg (+1sample = 6)
None
-
nd
-
6
-
9
-
11
Articular abscess, osteomyelitis of the femoral shaft
Renal failure, hepatitis, emphysema and abscess of the
lung
Thrombosis of the right femoral deep venous
Necrosis of the femoral neck and stiffening of the hip
4 years follow-up: geode of the metaphysis and bone
condensation of the femoral shaft.
Osteomyelitis of the distal part of the femur, myositis
Chronic osteomyelitis
Scintigraphy: normal 2 years later
3.5 years later: reconstruction of the femoral shaft
Osteomyelitis of the tibia, sub periosteal abscess,
bone infarction of the tibia
Necrotizing fasciitis
Fracture of the tibia (4 months): consolidation with
conservative treatment
Articular drainage of the hip
(2) (1d/9d) Femoral neck
trepanation (18d) Femoral
shaft trepanation (21d)
Total: 4 surg (+1 sample=5)
-
48
Surgical drainage (13d)
Total: 1 surg (+1 sample = 2)
-
44
Fasciotomy(4d), drainage of
sub periosteal abscess(5d)
Total: 2 surg
+
15
Fever > 39°5C
Disorders of the digestive system
Septic shock
WBC=2.8
4 days
Fever>40°C
Total functional disability of the
left leg
WBC=5
Arthritis
Right shoulder
Boil
24 h
Fever > 39°C
Septic shock
WBC=8.8
24 h
Case 6
M
14y1m
Osteomyelitis and
arthritis
Pelvis (ilio-pubial)
and right hip
None
Osteomyelitis
Right tibia
Superficial wound
24 h
Fever> 39°C
Knee pain and swelling
Case 7
M
3y6m
Arthritis
Right hip
Sty left eye
48 h
Fever> 39°C
Septic shock
Toxic shock syndrome (TSS)
WBC=11.5
Case 8
F
12y11m
Osteomyelitis
Left femoral shaft
None
12 h
Fever> 39°C
Septic shock
nd / nd
15 days IV
Per oral: 59 m
Blood cultures
Bone sample (1)
75 days/
75 days
X-ray
MRI
Scintigraphy
Case 9
M
5y10m
Osteomyelitis
Right tibia
Finger pulp
infection and
Superficial wound
24 h
Fever>39°c
WBC=16
35 days IV
Per oral: 6 m
Blood cultures
10 days/
45 days
X Rays
Scintigraphy
MRI
Case 10
M
9m
12 h
Fever > 39°5c
WBC=10.3
(28.1 at 3rd
day)
CRP=58.7
11days IV
Per oral: 3 weeks
Blood cultures
10 days/
14days
X Rays
Scintigraphy
Favourable outcome
None complication
None
-
22
Case 11
M
8y3m
Osteomyelitis and
arthritis
Distal left tibia
and ankle
None
Arthritis
Right knee
Superficial wound
24 h
Fever 39°c
10 days IV
Per oral: nd
Blood culture
Articular puncture (1)
4days/
10days
X Rays
MRI
Osteomyelitis of the femur, sub periosteal abscess,
arthritis of the knee
None
-
18
Case 12
M
12y8m
Osteomyelitis
Left tibia
Superficial wound
15 days
Fever>39°c
Septic shock
WBC=9.3
(5.3 at 3 rd
day)
CRP=163
WBC=14.7
Blood cultures
Abscess samples (3)
24days/
32 days
+ 8 m for
second therapy
X Rays
TDM
2 MRI
Scintigraphy
-
16
Osteomyelitis
Left femoral shaft
Boil
6 days
Osseous samples (2)
nd /
2 months
X Rays
Scintigraphy
TDM
MRI
Osteomyelitis of the tibia, sub periosteal abscess,
intramuscular abscess
Lung abscess, renal failure, hepatitis
Intra osseous sequester
1follow-up: abnormal x-ray and positive scingraphy but
no relapse infection on the TDM and the IRM
Osteomyélitis of the femoral shaft
Rib localisation
Fracture of the femoral shaft 3 weeks later initial onset
and first examination
Surgical drainages (3)
(1d/4d/17d) Surgical drainage
and sequestrectomy of the
distal tibia ( 6 months)
Total: 4 surg
Case 13
M
17y10m
** 2 months 17
days IV
Per oral: ***
6 months later:
5 weeks IV
Per oral: 6 m
2 m IV
Per oral: 2 m
-
12
Case14
M
7y4m
Osteomyelitis
Left tibial
Boil
24 h
12 days IV
Per oral: 28 days
Blood cultures
Osseous sample(1)
5days /
14 days
X Rays
MRI
Femoral shaft riming after one
month of antibiotic treatment
(30d) then osteosynthesis
(48d)
Total: 2 surg
None
+
12
CRP=215
CRP=415
CRP=124
Fever > 39°C
WBC=13.4
CRP=325
WBC=14.6
CRP=209
CRP=350
CRP=101
CRP=153
Fever 39°
Diagnosis was made 3 weeks
after initial onset (femoral shaft
fracture)
WBC=9.7
Fever 39°5c
Abdominal pain
WBC=17.6
CRP=185
Osteomyelitis of the left tibia
None complication
Excellent outcome 12 months later
CRP=102
nd: not documented, *: all surgical procedures underwent during hospitalization, if not the time of onset is noted, ** Initial treatment at 2nd day in an other country without benefit (unknow antibiotic during 8 days), *** The patient stopped the treatment 1 month later.
1
B Dohin et al.
On line appendix Table : Chronologic summerized presentation of the main clinical, biological and outcome datas of the 14 cases of PVL-positive BJI.
2
B Dohin et al.