CASO CLINICO / CASE REPORTS 69 Le Infezioni in Medicina, n. 1, 69-73, 2015 Corresponding author Alessandra Casuccio E-mail: alessandra.casuccio@unipa.it Leg ulcer and osteomyelitis due to methicillin-susceptible Staphylococcus aureus infection after fracture repair treatment: a case highlighting the potential role of prostaglandin E 1 vasodilator Ruolo della prostaglandina E 1 nel trattamento di una lesione ulcerosa con osteomielite causata da infezione da Staphylococcus aureus meticillino-sensibile dopo intervento chirurgico per frattura tibiale Erminia Bentivegna 1 , Emanuele Citarrella 2 , Roberto Vivaldi 2 , Dario De Luca 3 , Giovanna Grazia Maira 4 , Alessandra Casuccio 5 , Paola Di Carlo 5 1 Vascular Surgical Unit, Orestano Clinic, Palermo, Italy; 2 Orthopedic - Trauma Unit, Orestano Clinic, Palermo, Italy; 3 Department of Rehabilitation Medicine , Hospital District Palermo 3, Palermo, Italy; 4 Chief of regional medical Leadership of National Workers Compensation Authority (INAIL), Italy; 5 Department of Sciences for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Italy n INTRODUCTION I n order for antimicrobial therapy to be effec- tive, it is usually necessary to remove implanted devices. The formation of adherent, multilayered bacterial biofilms is the most important factor for the pathogenesis of medical device-related staphy- lococcal infections. Therefore, it is imperative that we develop a better understanding of the func- tional factors involved in biofilm formation, the mechanisms that regulate their expression, and the interaction between those potential virulence factors and the host in device-related infection [1, 2]. Important developments in the last few years may ultimately lead to judicious new approaches to prevention, diagnosis and treatment. The only sign of bone infection in non-diabetic and im- mune-competent patients may be a local symptom such as skin ulceration from a bony fistula. Some recent studies have shown that treatment with a combination of vasodilator prostaglandins, such as prostaglandin E1 (PGE 1 ) and prostaglandin E2 (PGE 2 ), and antibiotics can lead to a rapid recovery from osteomyelitis, without the need for orthope- dic surgery [3, 4]. The prostaglandins appear to reduce biofilm formation and chronicization of the infection, and stimulate a rapid and effective clearance of the infecting microorganism [5]. Here we report a case of recovery from Staphylococcus aureus osteomyelitis after management with anti- biotics, anti-thrombotics and PGE 1 vasodilator in a patient with previous tibial plateau fracture re- paired with internal fixation devices. n CASE REPORT In December 2013, a 47-year-old patient with osteomyelitis and chronic ulcer on the proximal third of his left leg was examined at the Ortho- brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by Archivio istituzionale della ricerca - Università di Palermo