Gupta Neha, Agashe Vikas, Soman Rajeev, Vidyarthi Kandarp, Gupta Rajiv, Sen Ishita, Koley Mrinalini, Veeraraghavan Balaji, Gupta Kailash
Department of Infectious Diseases, NG Swastha and Fortis Memorial Research Institute, Gurugram, India.
Department of Orthopaedics, P. D. Hinduja and Agashe Hospital, Mumbai, India.
JAC Antimicrob Resist. 2025 Jul 9;7(4):dlaf122. doi: 10.1093/jacamr/dlaf122. eCollection 2025 Aug.
Melioidosis, caused by , is a deadly infection with a case fatality rate of 10%-50%. Osteomyelitis, a rare manifestation, is particularly challenging due to diagnostic delays, misidentification, limited bone penetration of antibiotics and frequent relapses. Antibiotic intolerance emerges as a significant hurdle, with up to 26%-51% of patients developing severe allergies to trimethoprim/sulfamethoxazole, along with intolerability to ceftazidime and meropenem. These limitations demand innovative therapeutic approaches to combat this pathogen.
To report a novel case of -induced radial osteomyelitis successfully managed with levonadifloxacin, a broad-spectrum benzoquinolizine antibiotic, after intolerance to the conventional therapies.
A 59-year-old man presented with radial osteomyelitis requiring multiple rounds of surgical debridement. Severe allergic reactions to trimethoprim/sulfamethoxazole and ceftazidime, and meropenem-associated leukopenia made traditional therapies unfeasible. Levonadifloxacin was introduced as a salvage therapy, leveraging its efficacy against , favourable bone penetration, antibiofilm activity and tolerability. The patient received IV levonadifloxacin for 5 days, followed by almost 8 months of its oral prodrug, alalevonadifloxacin.
Levonadifloxacin emerged as the salvage therapy for this patient, achieving significant clinical improvement without relapse after more than 6 months of therapy cessation, despite the life-threatening combination of melioidosis-associated osteomyelitis and antibiotic intolerance. This first reported use of levonadifloxacin in melioidosis underscores its potential as an alternative therapy in such complex infections. Aggressive surgical intervention and tailored antimicrobial strategies remain crucial to overcoming these dual challenges.
由[病原体名称未给出]引起的类鼻疽病是一种致命感染，病死率为10%-50%。骨髓炎是一种罕见表现，由于诊断延迟、误诊、抗生素骨穿透性有限及频繁复发，其治疗极具挑战性。抗生素不耐受成为一个重大障碍，高达26%-51%的患者对甲氧苄啶/磺胺甲恶唑产生严重过敏，同时对头孢他啶和美罗培南也不耐受。这些局限性需要创新治疗方法来对抗这种病原体。
报告1例对传统疗法不耐受后，使用广谱苯并喹嗪类抗生素左诺氟沙星成功治疗[病原体名称未给出]所致桡骨骨髓炎的新病例。
一名59岁男性患者出现桡骨骨髓炎，需要进行多轮手术清创。对甲氧苄啶/磺胺甲恶唑和头孢他啶严重过敏，以及美罗培南相关的白细胞减少使传统疗法不可行。引入左诺氟沙星作为挽救疗法，利用其对[病原体名称未给出]的疗效、良好的骨穿透性、抗生物膜活性和耐受性。患者静脉注射左诺氟沙星5天，随后口服其前药阿拉左诺氟沙星近8个月。
左诺氟沙星成为该患者的挽救疗法，在停止治疗6个多月后无复发，临床显著改善，尽管类鼻疽病相关骨髓炎和抗生素不耐受这一危及生命的组合存在。首次报道左诺氟沙星用于类鼻疽病突出了其在这种复杂感染中作为替代疗法的潜力。积极的手术干预和定制的抗菌策略对于克服这些双重挑战仍然至关重要。
