Burkholderia cepacia Vertebral Osteomyelitis Following Cesarean Section: Case Report and Review of the Literature

The Burkholderia cepacia complex (Bcc) initially emerged as an important opportunistic pathogen in patients with predisposing lung disease. Bcc infections outside the respiratory tract are less common, although their incidence has been increasing particularly in immunocompromised patients. We herein describe the case of a healthy young woman who started experiencing low back pain 2 weeks after an uncomplicated cesarean section. She was found to have vertebral osteomyelitis at T12-L1. CT guided biopsy was performed, and cultures grew Bcc. She was treated with 3 weeks of meropenem and 5 weeks of oral trimethoprim-sulfamethoxazole with good response. No surgical intervention was warranted. We also performed a review of the literature on other existing reports. To the best of our knowledge, this is the first case of Bcc vertebral osteomyelitis in an immunocompetent patient following an obstetric procedure

Burkholderia cepacia Vertebral Osteomyelitis Following Cesarean Section: Case Report and Review of the Literature

The Burkholderia cepacia complex (Bcc) initially emerged as an important opportunistic pathogen in patients with predisposing lung disease. Bcc infections outside the respiratory tract are less common, although their incidence has been increasing particularly in immunocompromised patients. We herein describe the case of a healthy young woman who started experiencing low back pain 2 weeks after an uncomplicated cesarean section. She was found to have vertebral osteomyelitis at T12-L1. CT guided biopsy was performed, and cultures grew Bcc. She was treated with 3 weeks of meropenem and 5 weeks of oral trimethoprim-sulfamethoxazole with good response. No surgical intervention was warranted. We also performed a review of the literature on other existing reports. To the best of our knowledge, this is the first case of Bcc vertebral osteomyelitis in an immunocompetent patient following an obstetric procedure

Infective Endocarditis after Transcatheter Aortic Valve Replacement: Challenges in the Diagnosis and Management

Although initially conceived for high-risk patients who are ineligible for surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) is now recommended in a wider spectrum of indications, including among young patients. However, similar to SAVR, TAVR is also associated with a risk of infectious complications, namely, prosthetic valve endocarditis (PVE). As the number of performed TAVR procedures increases, and despite the low incidence of PVE post-TAVR, clinicians should be familiar with its associated risk factors and clinical presentation. Whereas the diagnosis of native valve endocarditis can be achieved straightforwardly by applying the modified Duke criteria, the diagnosis of PVE is more challenging given its atypical symptoms, the lower sensitivity of the criteria involved, and the low diagnostic yield of conventional echocardiography. Delay in proper management can be associated with increased morbidity and mortality. Therefore, clinicians should have a high index of suspicion and initiate proper work-up according to the severity of the illness, the underlying host, and the local epidemiology of the causative organisms. The most common causative pathogens are Gram-positive bacteria such as Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus spp., and Streptococcus spp. (particularly the viridans group), while less-likely causative pathogens include Gram-negative and fungal pathogens. The high prevalence of antimicrobial resistance complicates the choice of therapy. There remain controversies regarding the optimal management strategies including indications for surgical interventions. Surgical assessment is recommended early in the course of illness and surgical intervention should be considered in selected patients. As in other PVE, the duration of therapy depends on the isolated pathogen, the host, and the clinical response. Since TAVR is a relatively new procedure, the outcome of TAVR-PVE is yet to be fully understood