Implant-associated ESBL-Klebsiella pneumonia producing small colony variant bone and joint infection in a healthy 40-year-old man

Description

A 40-year-old man underwent a bifocal fracture of the left leg in Senegal. An intramedullar rod was implanted to obtain consolidation. At 7 months, the patient was admitted to our institution as the distal fracture had not consolidated (figure 1A). There was no clinical sign of infection. A 1-stage exchange of the rod was performed. No abscess or suspected tissue was detectable during the surgery. Systematic peroperative test of samples were performed, and revealed Klebsiella pneumonia producing extended-spectrum β-lactamase (ESBL), and some colonies expressed the small colony variant (SCV) phenotype in the culture (with the same antibiotic susceptibility), which was also identified to be K. pneumonia (figure 1 B and C). An early new intervention was required due to local abscess formation, the rod was explanted, the tibia was immobilised with a cruro-pedal cast and negative pressure therapy on the skin defect was instaured....

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