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Giri U, Thavalathil BC, Varghese R. Vertebral osteomyelitis in an immunosuppressed patient with rheumatoid arthritis. BMJ Case Rep 2014; 2014:bcr-2014-206944. [PMID: 25410035 DOI: 10.1136/bcr-2014-206944] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We report a case of spontaneous osteomyelitis of the cervical spine complicated by epidural abscess due to methicillin-resistant Staphylococcus aureus (MRSA) in a patient with rheumatoid arthritis with no obvious focus of infection or bacteraemia. The patient was on immunosuppressants and complete blood count revealed neutropaenia. He was successfully treated with intravenous antibiotics and surgery.
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Affiliation(s)
- Upama Giri
- Appalachian Regional Healthcare Hospital Inc, Hyden, Kentucky, USA
| | | | - Roy Varghese
- Appalachian Regional Healthcare Hospital Inc, Hyden, Kentucky, USA
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302
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Abstract
Although rare, thoracic osteomyelitis can occur when toxins from a catfish spine impalement to the hand spread via the blood. This article describes diagnosis and management of this condition in a man who required hospitalization for debilitating back pain that developed 3 weeks after the initial injury.
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303
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Outcome of culture-negative pyogenic vertebral osteomyelitis: Comparison with microbiologically confirmed pyogenic vertebral osteomyelitis. Semin Arthritis Rheum 2014; 44:246-52. [DOI: 10.1016/j.semarthrit.2014.04.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/19/2014] [Accepted: 04/21/2014] [Indexed: 11/20/2022]
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304
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Takahashi I, Kaneyasu Y, Yamamoto Y, Okumura T, Kenjo M, Kimura T, Murakami Y, Nagata Y. Radiation-induced pyogenic vertebral osteomyelitis after re-irradiation for para-aortic lymph node metastases in a patient with cervical cancer. Int Cancer Conf J 2014. [DOI: 10.1007/s13691-013-0145-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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305
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Kempen DHR, van Dijk M, Hoepelman AIM, Oner FC, Verlaan JJ. Extensive thoracolumbosacral vertebral osteomyelitis after Lemierre syndrome. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24 Suppl 4:S502-7. [PMID: 25245891 DOI: 10.1007/s00586-014-3576-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 09/04/2014] [Accepted: 09/04/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE To present a unique case of multilevel vertebral osteomyelitis after Lemierre syndrome. METHODS A previously healthy 27-year-old man presented in the Emergency Department in septic shock because of Lemierre syndrome for which he was subsequently treated with intravenous benzylpenicillin for 2 months. Two and a half months later, the patient was readmitted with severe back pain without neurological deficits or fever. Imaging revealed an extensive vertebral osteomyelitis of the complete thoracic, lumbar and sacral spine. RESULTS Although the blood cultures obtained at the initial admission for Lemierre syndrome revealed Fusobacterium species and Streptococcus milleri, the cultures from the spinal biopsies remained negative. Histology of the spinal biopsies showed a purulent sclerosing osteomyelitis. The patient was successfully treated with intravenous piperacillin and tazobactam. Despite persisting back pain, no recurrence of infection was seen at 3 years of follow-up. CONCLUSION Lemierre syndrome and an extensive thoracolumbosacral vertebral osteomyelitis are rare but serious infections. Clinicians must maintain a high index of suspicion for infectious metastases leading to vertebral osteomyelitis when a patient presents with back pain after an episode of life-threatening septicaemia caused by Lemierre syndrome.
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Affiliation(s)
- D H R Kempen
- Department of Orthopaedics, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands,
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306
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Aagaard T, Roed C, Larsen AR, Petersen A, Dahl B, Skinhøj P, Obel N. Long-term mortality after Staphylococcus aureus spondylodiscitis: A Danish nationwide population-based cohort study. J Infect 2014; 69:252-8. [DOI: 10.1016/j.jinf.2014.03.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/26/2014] [Accepted: 03/31/2014] [Indexed: 10/25/2022]
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307
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Nicolosi N, Pratt C. Infectious Spondylodiscitis, Epidural Phlegmon, and Psoas Abscess Complicating Diabetic Foot Infection: A Case Report. J Foot Ankle Surg 2014; 55:267-71. [PMID: 25128309 DOI: 10.1053/j.jfas.2014.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Indexed: 02/03/2023]
Abstract
Few published case reports have cited vertebral osteomyelitis as a sequela of a diabetic foot infection. The purpose of the present report is to increase awareness of a potentially severe complication of diabetic foot ulceration: vertebral osteomyelitis and associated pathologic features. We present the case of a 63-year-old male with right calcaneal osteomyelitis who developed acute onset lower back pain with concomitant fever and chills. Magnetic resonance imaging revealed L4-L5 vertebral osteomyelitis, a T9-L1 epidural abscess, and a right psoas muscle abscess secondary to hematogenous seeding from the calcaneus. The patient underwent right partial calcanectomy, spinal and right psoas abscess incision and drainage, and direct lumbar interbody fusion of L4-L5 with a right iliac crest allograft. All bone, blood, and abscess cultures were positive for methicillin-resistant Staphylococcus aureus. After the surgery, the patient's pain resolved in his back and hip and he regained full right lower extremity function. The 1-year follow-up examination revealed that the patient had vertebral arthritis but was able to perform his activities of daily living with a walker and cane. It is important to recognize the potential complications of diabetic foot ulcerations and be aware of the identifying symptoms and treatment options for this condition to prevent significant morbidity and mortality.
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Affiliation(s)
- Nicole Nicolosi
- Resident, Podiatric Medicine and Surgery, HealthSpan/Cleveland Clinic, Cleveland, OH.
| | - Christina Pratt
- Resident, Podiatric Medicine and Surgery, HealthSpan/Cleveland Clinic, Cleveland, OH
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308
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Mohamed AS, Yoo J, Hart R, Ragel BT, Hiratzka J, Hamilton DK, Barnes PD, Ching AC. Posterior fixation without debridement for vertebral body osteomyelitis and discitis. Neurosurg Focus 2014; 37:E6. [DOI: 10.3171/2014.6.focus14142] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors evaluated the efficacy of posterior instrumentation for the management of spontaneous spinal infections. Standard surgical management of spontaneous spinal infection is based on debridement of the infected tissue. However, this can be very challenging as most of these patients are medically debilitated and the surgical debridement requires a more aggressive approach to the spine either anteriorly or via an expanded posterior approach. The authors present their results using an alternative treatment method of posterior-only neuro-decompression and stabilization without formal debridement of anterior tissue for treating spontaneous spinal infection.
Methods
Fifteen consecutive patients were treated surgically by 2 of the authors. All patients had osteomyelitis and discitis and were treated postoperatively with intravenous antibiotics for at least 6 weeks. The indications for surgery were failed medical management, progressive deformity with ongoing persistent spinal infection, or neurological deficit. Patients with simple epidural abscess without bony instability were treated with laminectomy and were not included in this series. Fourteen patients were treated with posterior-only decompression and long-segment rigid fixation, without formal debridement of the infected area. One patient was treated with staged anterior and posterior surgery due to delay in treatment related to medical comorbidities. The authors examined as their outcome the ambulatory status and recurrence of deep infection requiring additional surgery or medical treatment.
Results
Of the initial 15 patients, 10 (66%) had a minimum 2-year follow-up and 14 patients had at least 1 year of followup. There were no recurrent spinal infections. There were 3 unplanned reoperations (1 for loss of fixation, 1 for early superficial wound infection, and 1 for epidural hematoma). Nine (60%) of 15 patients were nonambulatory at presentation. At final followup, 8 of 15 patients were independently ambulatory, 6 required an assistive device, and 1 remained nonambulatory.
Conclusions
Long-segment fixation, without formal debridement, resulted in resolution of spinal infection in all cases and in significant neurological recovery in almost all cases. This surgical technique, when combined with aggressive antibiotic therapy and a multidisciplinary team approach, is an effective way of managing serious spinal infections in a challenging patient population.
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Affiliation(s)
| | - Jung Yoo
- Departments of 1Orthopedics and Rehabilitation and
| | - Robert Hart
- Departments of 1Orthopedics and Rehabilitation and
| | - Brian T. Ragel
- 2Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | | | - D. Kojo Hamilton
- 2Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | - Penelope D. Barnes
- 2Neurological Surgery, Oregon Health & Science University, Portland, Oregon
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309
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Clinical characteristics and outcomes of hematogenous vertebral osteomyelitis caused by gram-negative bacteria. J Infect 2014; 69:42-50. [DOI: 10.1016/j.jinf.2014.02.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 02/02/2014] [Accepted: 02/13/2014] [Indexed: 11/23/2022]
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310
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The unique clinical features and outcome of infectious endocarditis and vertebral osteomyelitis co-infection. Am J Med 2014; 127:669.e9-669.e15. [PMID: 24608019 DOI: 10.1016/j.amjmed.2014.02.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 01/28/2014] [Accepted: 02/10/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The clinical significance of vertebral osteomyelitis and infectious endocarditis co-infection is unclear. This study investigates the rate, clinical features, and outcome of vertebral osteomyelitis with and without concomitant infectious endocarditis. METHODS A retrospective study of all cases of osteomyelitis with spinal imaging (n = 176), from January 2007 to April 2013, that were diagnosed as vertebral osteomyelitis. Sixty-two patients with spontaneous vertebral osteomyelitis were identified after excluding postsurgical, decubitus ulcers and spinal metastases. Seventeen (27%) were identified with concomitant infectious endocarditis. RESULTS All patients presented with back pain and 59% were diagnosed with infectious endocarditis subsequent to vertebral osteomyelitis. Distinguishing features among the co-infection group include the increased use of transesophageal echocardiography (94% vs 58%, P = .004), predisposing cardiac conditions (59% vs 16%, P = .001), and Gram-positive bacteremia, of which Streptococcus sp. and Enterococcus sp. were more common (35% vs 11%, P = .026). Adverse neurologic events were increased significantly in the co-infection group (59% vs 22%, P = .006). On transesophageal echocardiography, 88% of co-infection patients had highly mobile vegetations, 9 of which measured 10 mm or more. The overall mortality was 41% and 29% in the co-infection and lone vertebral osteomyelitis groups, respectively (P = .356). One-year mortality was identical for both groups at 24% (P = .999), and higher than previously reported (11.3% for lone vertebral osteomyelitis). CONCLUSIONS Patients with vertebral osteomyelitis, in whom infectious endocarditis is not excluded, are at increased risk for adverse neurologic events and mortality. The prompt diagnosis of infectious endocarditis, and associated high-risk features that may benefit from surgical intervention, require early evaluation by transesophageal echocardiography.
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311
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Comparative Analysis of Daptomycin and Vancomycin in the Treatment of Vertebral Osteomyelitis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0000000000000116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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312
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313
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Cariati VP, Deng W. Atypical presentation of thoracic spondylodiscitis caused by Streptococcus mitis. BMJ Case Rep 2014; 2014:bcr-2013-200532. [PMID: 24842345 DOI: 10.1136/bcr-2013-200532] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Spondylodiscitis, which is most commonly caused by Staphylococcus aureus, is an uncommon infection in adults. The diagnosis of spondylodiscitis is often delayed by its vague and non-specific presentations. As part of the normal flora in human mouth and sinuses, Streptococcus mitis is a very rare cause of spondylodiscitis. We report a case of thoracic spondylodiscitis caused by S. mitis in a patient with chronic sinusitis. The patient atypically presented with a sharp chest pain that radiated to the back and the imaging studies were initially negative. He failed outpatient pain management and the diagnosis of spondylodiscitis was confirmed by bone biopsy 6 weeks later. Treatment with antibiotics completely alleviated the pain. Increased awareness and a high index of suspicion are essential for early diagnosis of spondylodiscitis with an atypical presentation.
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Affiliation(s)
- Vincent P Cariati
- Department of Internal Medicine, Scottsdale Healthcare, Shea Hospital, Scottsdale, Arizona, USA
| | - Wu Deng
- University of California, Irvine, California, USA
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314
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Koehler P, Tacke D, Cornely OA. Bone and joint infections by Mucorales, Scedosporium, Fusarium and even rarer fungi. Crit Rev Microbiol 2014; 42:158-71. [DOI: 10.3109/1040841x.2014.910749] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Philipp Koehler
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany,
- Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne, Cologne, Germany,
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Medical Faculty, University of Cologne, Cologne, Germany,
| | - Daniela Tacke
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany,
- Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne, Cologne, Germany,
| | - Oliver A. Cornely
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany,
- Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne, Cologne, Germany,
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Medical Faculty, University of Cologne, Cologne, Germany,
- Clinical Trials Centre Cologne, ZKS Köln, BMBF 01KN1106, Medical Faculty, University of Cologne, Cologne, Germany, and
- German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
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315
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Shepard M, Safain M, Burke SM, Hwang S, Kryzanski J, Riesenburger RI. Lateral retroperitoneal transpsoas approach to the lumbar spine for the treatment of spondylodiscitis. MINIM INVASIV THER 2014; 23:309-12. [PMID: 24773372 DOI: 10.3109/13645706.2014.908924] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Spondylodiscitis is an infection of the intervertebral disc and adjacent vertebrae. With the advent of minimally invasive spinal surgery, less invasive approaches have been considered for the treatment of discitis. To date, however, there have been no reported cases of a minimally invasive lateral retroperitoneal transpsoas approach for the treatment of spondylodiscitis. The authors report a case of medically refractory discitis in a patient with multiple comorbidities who underwent a successful limited debridement via a lateral transpsoas corridor. This case describes a minimally invasive approach used to treat a patient with lumbar discitis/osteomyelitis who was otherwise a suboptimal surgical candidate.
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Affiliation(s)
- Matthew Shepard
- Tufts Medical Center, Department of Neurosurgery , Boston, MA , USA
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316
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Babouee Flury B, Elzi L, Kolbe M, Frei R, Weisser M, Schären S, Widmer AF, Battegay M. Is switching to an oral antibiotic regimen safe after 2 weeks of intravenous treatment for primary bacterial vertebral osteomyelitis? BMC Infect Dis 2014; 14:226. [PMID: 24767169 PMCID: PMC4012835 DOI: 10.1186/1471-2334-14-226] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 04/17/2014] [Indexed: 12/18/2022] Open
Abstract
Background Vertebral osteomyelitis (VO) may lead to disabling neurologic complications. Little evidence exists on optimal antibiotic management. Methods All patients with primary, non-implant VO, admitted from 2000–2010 were retrospectively analyzed. Patients with endocarditis, immunodeficiency, vertebral implants and surgical site infection following spine surgery were excluded. Persistence of clinical or laboratory signs of inflammation at 1 year were defined as treatment failure. Logistic regression was used to estimate the odds ratios (OR) of switch to an oral regimen after 2 weeks. Results Median antibiotic treatment was 8.1 weeks in 61 identified patients. Switch to oral antibiotics was performed in 72% of patients after a median intravenous therapy of 2.7 weeks. Switch to oral therapy was already performed after two weeks in 34% of the patients. A lower CRP at 2 weeks was the only independent predictor for switch to oral therapy (OR 0.7, 95% confidence interval 0.5-0.9, p = 0.041, per 10 mg/l increase). Staphylococcus aureus was the most frequently isolated microorganism (21%). Indications for surgery, other than biopsy, included debridement with drainage of epidural or paravertebral abscess (26 patients; 42%), and CT - guided drainage (3 patients). During the follow-up, no recurrences were observed but 2 patients died of other reasons than VO, i.e. the 1 year intention to treat success rate was 97%. Conclusions Cure rates for non-implant VO were very high with partly short intravenous and overall antibiotic therapy. Switching to an oral antibiotic regimen after two weeks intravenous treatment may be safe, provided that CRP has decreased and epidural or paravertebral abscesses of significant size have been drained.
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Affiliation(s)
- Baharak Babouee Flury
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Petersgraben 4, Basel 4031, Switzerland.
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317
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Kehrer M, Pedersen C, Jensen TG, Lassen AT. Increasing incidence of pyogenic spondylodiscitis: A 14-year population-based study. J Infect 2014; 68:313-20. [DOI: 10.1016/j.jinf.2013.11.011] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 10/31/2013] [Accepted: 11/22/2013] [Indexed: 10/25/2022]
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318
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Chahoud J, Kanafani Z, Kanj SS. Surgical site infections following spine surgery: eliminating the controversies in the diagnosis. Front Med (Lausanne) 2014; 1:7. [PMID: 25705620 PMCID: PMC4335387 DOI: 10.3389/fmed.2014.00007] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 03/13/2014] [Indexed: 12/19/2022] Open
Abstract
Surgical site infection (SSI) following spine surgery is a dreaded complication with significant morbidity and economic burden. SSIs following spine surgery can be superficial, characterized by obvious wound drainage or deep-seated with a healed wound. Staphylococcus aureus remains the principal causal agent. There are certain pre-operative risk factors that increase the risk of SSI, mainly diabetes, smoking, steroids, and peri-operative transfusions. Additionally, intra-operative risk factors include surgical invasiveness, type of fusion, implant use, and traditional instead of minimally invasive approach. A high level of suspicion is crucial to attaining an early definitive diagnosis and initiating appropriate management. The most common presenting symptom is back pain, usually manifesting 2–4 weeks and up to 3 months after a spinal procedure. Scheduling a follow-up visit between weeks 2 and 4 after surgery is therefore necessary for early detection. Inflammatory markers are important diagnostic tools, and comparing pre-operative with post-operative levels should be done when suspecting SSIs following spine surgery. Particularly, serum amyloid A is a novel inflammatory marker that can expedite the diagnosis of SSIs. Magnetic resonance imaging remains the diagnostic modality of choice when suspecting a SSI following spine surgery. While 18F-fluorodeoxyglucose-positron emission tomography is not widely used, it may be useful in challenging cases. Despite their low yield, blood cultures should be collected before initiating antibiotic therapy. Samples from wound drainage should be sent for Gram stain and cultures. When there is a high clinical suspicion of SSI and in the absence of superficial wound drainage, computed tomography-guided aspiration of paraspinal collections is warranted. Unless the patient is hemodynamically compromised, antibiotics should be deferred until proper specimens for culture are secured.
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Affiliation(s)
- Jad Chahoud
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center , Beirut , Lebanon
| | - Zeina Kanafani
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center , Beirut , Lebanon
| | - Souha S Kanj
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center , Beirut , Lebanon
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319
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Garkowski A, Zajkowska A, Czupryna P, Łebkowski W, Letmanowski M, Gołębicki P, Moniuszko A, Ustymowicz A, Pancewicz S, Zajkowska J. Infectious spondylodiscitis - a case series analysis. Adv Med Sci 2014; 59:57-60. [PMID: 24797976 DOI: 10.1016/j.advms.2014.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 08/02/2013] [Indexed: 12/17/2022]
Abstract
PURPOSE We aimed to describe the clinical and laboratory features as well as diagnostic difficulties in the case series of spondylodiscitis. MATERIALS/METHODS We retrospectively reviewed 11 cases of spondylodiscitis. The diagnosis of spondylodiscitis was based on clinical, radiological and microbiological evidence and by the response to antimicrobial therapy. RESULTS There were 7 men and 4 women, and the age ranged from 21 to 74 years. Risk factors of spondylodiscitis were observed in 7 patients. The approximate time from onset of symptoms to diagnosis was from 2 to 7 months (median 45 days). Back pain was the most common symptom. The most frequent location of spondylodiscitis was lumbar spine. Pathogens were isolated in 6 cases and were as follows: Staphylococcus aureus (4 cases), Staphylococcus warneri (1 case) and Escherichia coli (1 case). After therapy, all patients had rapid regression of symptoms and no permanent neurological impairments and recurrence of infection were observed. CONCLUSIONS Diagnosis of spondylodiscitis is frequently delayed. This disease should be taken into consideration in differential diagnosis in patients with root syndromes accompanied by back pain and usually fever as well as increased values of CRP and ESR.
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320
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Kuba K, Inoue H, Matsumura S, Minami K, Takajo F, Morita K, Nakahira M, Sugasawa M. [Case of pyogenic spondylitis and epidural abscess after chemoradiotherapy for hypopharyngeal cancer]. NIHON JIBIINKOKA GAKKAI KAIHO 2014; 116:1326-31. [PMID: 24558949 DOI: 10.3950/jibiinkoka.116.1326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Osteomyelitis is one of the most severe late complications of radiation therapy. The condition can arise from osteoradionecrosis and can be fatal if it occurrs in vertebrae. A 71-year-old woman, who had undergone chemoradiotherapy for hypopharyngeal cancer 6 months previously, presented with severe neck pain. An MRI examination revealed pyogenic spondylitis and an epidural abscess of the neck. Neurological disturbance in the extremities developed despite the administration of antibiotics for 5 days. Drainage and a laminectomy were performed to control the infection and to relieve spinal cord compression. The patient had no postoperative complications at 15 months after surgery. Previous case reports of osteomyelitis and epidural abscess following radiation therapy for head and neck cancer with surgical treatment tended to have a good clinical course. Severe neck pain and a limitation in the range of motion of the neck are considered to be serious clinical features of osteomyelitis. Since infection in the necrotic mucosa leads to pyogenic spondylitis, a repeated cultivation survey of the mucosa is nessesary for adequate antibiotics therapy. For osteomyelitis and epidural abscess following radiation therapy, immediate specific surgical treatment of the involved region is strongly suggested if antibiotics are not effective or spinal cord compression develops.
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Affiliation(s)
- Kiyomi Kuba
- Department of Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Hidaka
| | - Hitoshi Inoue
- Department of Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Hidaka
| | - Satoko Matsumura
- Department of Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Hidaka
| | - Kazuhiko Minami
- Department of Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Hidaka
| | - Fumihiko Takajo
- Department of Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Hidaka
| | - Kei Morita
- Department of Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Hidaka
| | - Mitsuhiko Nakahira
- Department of Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Hidaka
| | - Masashi Sugasawa
- Department of Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Hidaka
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321
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Choe H, Aota Y, Kobayashi N, Nakamura Y, Wakayama Y, Inaba Y, Saito T. Rapid sensitive molecular diagnosis of pyogenic spinal infections using methicillin-resistant Staphylococcus-specific polymerase chain reaction and 16S ribosomal RNA gene-based universal polymerase chain reaction. Spine J 2014; 14:255-62. [PMID: 24231777 DOI: 10.1016/j.spinee.2013.10.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 10/19/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Rapid diagnosis and accurate detection of etiological agents in pyogenic spinal infection (PSI) patients are important. PURPOSE The purpose of this study was to evaluate the clinical usefulness of methicillin-resistant Staphylococcus-specific polymerase chain reaction (MRS-PCR) and broad-range universal PCR (U-PCR) for diagnosing PSI. STUDY DESIGN A prospective diagnostic study. PATIENTS Thirty-two clinically suspect PSI patients and six control patients who underwent computerized tomography-guided biopsy and/or surgical treatment were enrolled. METHODS Tissue samples were examined by microbiological culture, histopathology, and real-time PCR (MRS-PCR and U-PCR). The diagnostic accuracy of real-time PCR was analyzed based on the definitive diagnosis of infection, defined as a positive result from microbiological culture or histopathology. RESULTS All six control subjects were negative for PSI for all analyses. Twelve clinically suspect PSI subjects received definitive diagnoses (PSI group). The non-PSI group consisted of six control subjects plus the remaining 20 patients from the PSI clinically suspect group. MRS-PCR results were positive for all MRS-cultured PSI subjects. U-PCR was positive for all subjects in the PSI group with one discrepancy between real-time PCR and microbiological culture results in differentiation between gram-positive and gram-negative bacteria. In the non-PSI group, MRS-PCR and U-PCR were positive in three and seven cases, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of MRS-PCR for diagnosing MRS infection were 1.00, 0.91, 0.57, and 1.00, respectively; those for the diagnosis of bacterial infection with U-PCR were 1.00, 0.73, 0.63, and 1.00, respectively. CONCLUSION Identification of MRS infection and ability to differentiate between gram-positive and gram-negative bacteria is rapidly achieved using MRS-PCR and U-PCR. Real-time PCR provides a sensitive molecular diagnosis of PSI and may contribute to antibiotic selection.
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Affiliation(s)
- Hyonmin Choe
- Yokohama City University School of Medicine, Department of Orthopaedic Surgery, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan.
| | - Yoichi Aota
- Yokohama City University School of Medicine, Department of Orthopaedic Surgery, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Naomi Kobayashi
- Yokohama City University School of Medicine, Department of Orthopaedic Surgery, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Yushi Nakamura
- Yokohama City University School of Medicine, Department of Orthopaedic Surgery, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Yusuke Wakayama
- Yokohama City University School of Medicine, Department of Orthopaedic Surgery, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Yutaka Inaba
- Yokohama City University School of Medicine, Department of Orthopaedic Surgery, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Tomoyuki Saito
- Yokohama City University School of Medicine, Department of Orthopaedic Surgery, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
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322
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Siddiq DM, Musher DM, Darouiche RO. Spinal and paraspinal pneumococcal infections—a review. Eur J Clin Microbiol Infect Dis 2014; 33:517-27. [DOI: 10.1007/s10096-013-1997-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 10/08/2013] [Indexed: 11/30/2022]
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323
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Weissman S, Parker RD, Siddiqui W, Dykema S, Horvath J. Vertebral osteomyelitis: Retrospective review of 11 years of experience. ACTA ACUST UNITED AC 2014; 46:193-9. [DOI: 10.3109/00365548.2013.868600] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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324
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Loibl M, Stoyanov L, Doenitz C, Brawanski A, Wiggermann P, Krutsch W, Nerlich M, Oszwald M, Neumann C, Salzberger B, Hanses F. Outcome-related co-factors in 105 cases of vertebral osteomyelitis in a tertiary care hospital. Infection 2014; 42:503-10. [DOI: 10.1007/s15010-013-0582-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 12/26/2013] [Indexed: 12/15/2022]
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325
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Koehler P, Tacke D, Cornely OA. Aspergillosis of bones and joints - a review from 2002 until today. Mycoses 2014; 57:323-35. [DOI: 10.1111/myc.12165] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 12/03/2013] [Accepted: 12/03/2013] [Indexed: 12/29/2022]
Affiliation(s)
- Philipp Koehler
- 1st Department of Internal Medicine; University Hospital of Cologne; Zentrum für Klinische Studien (BMBF 01KN1106); CECAD - Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases; Cologne Germany
| | - Daniela Tacke
- 1st Department of Internal Medicine; University Hospital of Cologne; Zentrum für Klinische Studien (BMBF 01KN1106); CECAD - Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases; Cologne Germany
| | - Oliver A. Cornely
- 1st Department of Internal Medicine; University Hospital of Cologne; Zentrum für Klinische Studien (BMBF 01KN1106); CECAD - Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases; Cologne Germany
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326
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Murillo O, Roset A, Sobrino B, Lora-Tamayo J, Verdaguer R, Jiménez-Mejias E, Nolla J, de Colmenero J, Ariza J. Streptococcal vertebral osteomyelitis: multiple faces of the same disease. Clin Microbiol Infect 2014; 20:O33-8. [DOI: 10.1111/1469-0691.12302] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 06/06/2013] [Accepted: 06/16/2013] [Indexed: 11/28/2022]
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327
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Abstract
Even at a time when HIV/AIDS and immunosuppressive therapy have increased the number of individuals living with significant immunocompromise, diabetes mellitus (DM) remains a major comorbid disorder for several rare but potentially lethal infections, including rhino-orbital-cerebral mucormycosis and malignant external otitis. DM is also a commonly associated condition in patients with nontropical pyomyositis, pyogenic spinal infections, Listeria meningitis, and blastomycosis. As West Nile virus spread to and across North America over a decade ago, DM appeared in many series as a risk factor for death or neuroinvasive disease. More recently, in several large international population-based studies, DM was identified as a risk factor for herpes zoster. The relationships among infection, DM, and the nervous system are multidirectional. Viral infections have been implicated in the pathogenesis of type 1 and type 2 DM, while parasitic infections have been hypothesized to protect against autoimmune disorders, including type 1 DM. DM-related neurologic disease can predispose to systemic infection - polyneuropathy is the predominant risk factor for diabetic foot infection. Because prognosis for many neurologic infections depends on timely institution of antimicrobial and sometimes surgical therapy, neurologists caring for diabetic patients should be familiar with the clinical features of the neuroinfectious syndromes associated with DM.
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Affiliation(s)
- Cheryl A Jay
- Department of Neurology, University of California San Francisco and Neurology Service, San Francisco General Hospital, San Francisco, CA, USA.
| | - Marylou V Solbrig
- Departments of Internal Medicine (Neurology) and Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
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328
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Usefulness of a direct 16S rRNA gene PCR assay of percutaneous biopsies or aspirates for etiological diagnosis of vertebral osteomyelitis. Diagn Microbiol Infect Dis 2014; 78:75-8. [DOI: 10.1016/j.diagmicrobio.2013.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 09/30/2013] [Accepted: 10/05/2013] [Indexed: 11/18/2022]
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329
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Zefelippo A, Bertazzoni PM, Marini AM, De Rai P, Contessini-Avesani E. Pyogenic vertebral osteomyelitis complicating abdominal penetrating injury: case report and review of the literature. World J Emerg Surg 2013; 8:56. [PMID: 24373134 PMCID: PMC3881493 DOI: 10.1186/1749-7922-8-56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 12/26/2013] [Indexed: 12/18/2022] Open
Abstract
Pyogenic vertebral osteomyelitis is a rare condition usually associated with endocarditis or spinal surgery. However, it may also occur following abdominal penetrating trauma with associated gastrointestinal perforation. Diagnosis might be challenging and appropriate treatment is essential to ensure a positive outcome. In trans-abdominal trauma, 48 hours of broad-spectrum antibiotics is generally recommended for prophylaxis of secondary infections. A case report of vertebral osteomyelitis complicating trans-colonic injury to the retroperitoneum is presented and clinical management is discussed in the light of literature review.
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Affiliation(s)
- Arianna Zefelippo
- General and Emergency Surgery Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, via F, Sforza 35-20100, Milano, Italy.
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330
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Factors associated with treatment failure in vertebral osteomyelitis requiring spinal instrumentation. Antimicrob Agents Chemother 2013; 58:880-4. [PMID: 24277039 DOI: 10.1128/aac.01452-13] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Patients with vertebral osteomyelitis may require instrumentation for spinal stabilization. Determining the optimal duration and type of antimicrobial therapy for these patients is challenging. The aim of this study was to examine risk factors for treatment failure, in particular antimicrobial duration, in a cohort of patients requiring spinal instrumentation for vertebral osteomyelitis. We conducted a retrospective cohort study of all patients with vertebral osteomyelitis who had spinal instrumentation between January 2002 and January 2012 at the University of Maryland Medical Center. The primary outcome measure was treatment failure >4 weeks postoperatively. We identified 131 patients with vertebral osteomyelitis requiring spinal instrumentation, 94 of whom had >4 weeks of follow-up and were included in the primary analysis. Treatment failure occurred in 22 of the 94 patients (23%) at a median of 4 months after surgery. Among patients who failed therapy, 20 of 22 failed within 1 year of surgery. Cervical and thoracic infection sites and the presence of negative cultures were associated with fewer treatment failures. Addition of rifampin and the use of chronic suppressive antimicrobials did not affect treatment failure rate. Twenty-three percent of patients with spinal instrumentation for vertebral osteomyelitis experienced treatment failure. Treatment failure almost always occurred within the first year of spinal instrumentation.
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331
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Lee WS, Chen YC, Chen HP, Chen TH, Cheng CY. Vertebral osteomyelitis caused by vancomycin-tolerant methicillin-resistant Staphylococcus aureus bacteremia: Experience with teicoplanin plus fosfomycin combination therapy. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 49:600-3. [PMID: 24269007 DOI: 10.1016/j.jmii.2013.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 08/30/2013] [Accepted: 09/03/2013] [Indexed: 11/25/2022]
Abstract
An 85-year-old female presented with fever and consciousness disturbance for 3 days. The patient's blood culture subsequently revealed persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia despite the administration of vancomycin or teicoplanin monotherapy. Gallium inflammation scan and magnetic resonance image of the spine disclosed osteomyelitis and discitis at the level of L4-5. Surgical debridement was not feasible in this debilitated patient. Because of the creeping minimal inhibitory concentration of vancomycin of the causative isolate (1.5 μg/mL) and clinical failure with glycopeptide monotherapy, we changed the antibiotic therapy to a fosfomycin and teicoplanin combination therapy. The patient showed improved clinical response in terms of her enhanced consciousness as well as subsidence of persisted bacteremia. Despite the potential side effects of fosfomycin (such as diarrhea and hypernatremia), it combined with a glycopeptide may be an alternative therapy for invasive refractory MRSA infections.
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Affiliation(s)
- Wen-Sen Lee
- Section of Infectious Disease, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taiwan.
| | - Yen-Chuo Chen
- Section of Nephrology, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taiwan
| | - Hung-Ping Chen
- Section of Nephrology, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taiwan
| | - Tso-Hsiao Chen
- Section of Nephrology, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taiwan
| | - Chung-Yi Cheng
- Section of Nephrology, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taiwan.
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332
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Antimicrobial-related severe adverse events during treatment of bone and joint infection due to methicillin-susceptible Staphylococcus aureus. Antimicrob Agents Chemother 2013; 58:746-55. [PMID: 24247130 DOI: 10.1128/aac.02032-13] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Prolonged antimicrobial therapy is recommended for methicillin-susceptible Staphylococcus aureus (MSSA) bone and joint infections (BJI), but its safety profile and risk factors for severe adverse events (SAE) in clinical practice are unknown. We addressed these issues in a retrospective cohort study (2001 to 2011) analyzing antimicrobial-related SAE (defined according to the Common Terminology Criteria for Adverse Events) in 200 patients (male, 62%; median age, 60.8 years [interquartile range {IQR}, 45.5 to 74.2 years]) with MSSA BJI admitted to a reference regional center with acute (66%) or chronic arthritis (7.5%), osteomyelitis (9.5%), spondylodiscitis (16%), or orthopedic device-related infections (67%). These patients received antistaphylococcal therapy for a median of 26.6 weeks (IQR, 16.8 to 37.8 weeks). Thirty-eight SAE occurred in 30 patients (15%), with a median time delay of 34 days (IQR, 14.75 to 60.5 days), including 10 patients with hematologic reactions, 9 with cutaneomucosal reactions, 6 with acute renal injuries, 4 with hypokalemia, and 4 with cholestatic hepatitis. The most frequently implicated antimicrobials were antistaphylococcal penicillins (ASP) (13 SAE/145 patients), fluoroquinolones (12 SAE/187 patients), glycopeptides (9 SAE/101 patients), and rifampin (7 SAE/107 patients). Kaplan-Meier curves and stepwise binary logistic regression analyses were used to determine the risk factors for the occurrence of antimicrobial-related SAE. Age (odds ratio [OR], 1.479 for 10-year increase; 95% confidence interval [CI], 1.116 to 1.960; P = 0.006) appeared to be the only independent risk factor for SAE. In patients receiving ASP or rifampin, daily dose (OR, 1.028; 95% CI, 1.006 to 1.051; P = 0.014) and obesity (OR, 8.991; 95% CI, 1.453 to 55.627; P = 0.018) were associated with the occurrence of SAE. The high rate of SAE and their determinants highlighted the importance of the management and follow-up of BJI, with particular attention to be paid to older persons, especially for ASP dosage, and to rifampin dose adjustment in obese patients.
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333
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Oksi J, Finnilä T, Hohenthal U, Rantakokko-Jalava K. Candida dubliniensis spondylodiscitis in an immunocompetent patient. Case report and review of the literature. Med Mycol Case Rep 2013; 3:4-7. [PMID: 24567891 PMCID: PMC3930959 DOI: 10.1016/j.mmcr.2013.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 11/04/2013] [Indexed: 12/17/2022] Open
Abstract
We describe what appears to be the first case of spondylodiscitis due to Candida dubliniensis. Our case adds to the current literature of the importance of C. dubliniensis as a cause of fungemia and subsequent deep seated infections. It highlights the importance of taking fungal as well as bacterial culture from biopsy specimens in patients with spondylodiscitis. We also review the literature covering the reported cases of Candida spondylodiscitis, which amount to about 100 over the last 5 decades.
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Affiliation(s)
- Jarmo Oksi
- Department of Infectious Diseases, Division of Medicine, Turku University Hospital, Turku, Finland
- Faculty of Medicine, University of Turku, Turku, Finland
- Corresponding author at: Department of Infectious Diseases, Division of Medicine, Turku University Hospital, Turku, Finland. Tel.: +358 2 3130786.
| | - Taru Finnilä
- Department of Infectious Diseases, Division of Medicine, Turku University Hospital, Turku, Finland
| | - Ulla Hohenthal
- Department of Infectious Diseases, Division of Medicine, Turku University Hospital, Turku, Finland
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334
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Suzuki H, Shichi D, Tokuda Y, Ishikawa H, Maeno T, Nakamura H. Pneumococcal vertebral osteomyelitis at three teaching hospitals in Japan, 2003-2011: analysis of 14 cases and a review of the literature. BMC Infect Dis 2013; 13:525. [PMID: 24209735 PMCID: PMC3833677 DOI: 10.1186/1471-2334-13-525] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 11/04/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pneumococcal vertebral osteomyelitis (PVO) is a rare disease whose clinical characteristics have not been clarified. This study aimed to investigate the clinical features and outcomes of patients with PVO. METHODS We retrospectively evaluated all adult patients diagnosed with PVO at three teaching hospitals in Japan from January 2003 to December 2011. All cases were identified through a review of the medical records of patients with invasive pneumococcal disease (IPD). RESULTS Among 208 patients with IPD, we identified 14 with PVO (6.4%; 95% CI, 3.5-10%). All 14 patients (nine male, five female; median age 69 years) had acquired PVO outside the hospital and had no recent history of an invasive procedure or back injury. Five patients (36%) had diabetes mellitus, and four (29%) had heavy alcohol intake. Fever (n = 13; 93%) or back pain/neck pain (n = 12; 86%) were present in most patients. The lumbar spine was affected in nine patients (64%) but the cervical spine was the site of infection in four patients (29%). All patients except one had a positive blood culture for Streptococcus pneumoniae, and there were no distant infected sites in most patients (n = 10; 71%). Intravenous beta-lactam therapy was initiated within 1 week after the onset of symptoms in 11 patients (79%). No patients died within 30 days, but one patient died from aspiration pneumonia on day 37 after admission. CONCLUSIONS PVO was relatively common among adult patients with IPD, and mortality was low in this study. S. pneumoniae may be the causative pathogen of vertebral osteomyelitis, especially among community-onset cases without a history of invasive procedures or back injury.
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Affiliation(s)
- Hiromichi Suzuki
- Department of Clinical Laboratory Medicine, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba 305-8558, Japan.
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335
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Mugera C, Suh KJ, Huisman TAGM, Weber K, Belzberg AJ, Carrino JA, Chhabra A. Sclerotic lesions of the spine: MRI assessment. J Magn Reson Imaging 2013; 38:1310-24. [PMID: 24123379 DOI: 10.1002/jmri.24247] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 05/07/2013] [Indexed: 01/08/2023] Open
Abstract
Sclerotic (T2 dark) lesions of the spine are infrequent and, as a result, these are often missed or misdiagnosed. Plain films may not be always available during magnetic resonance imaging (MRI) readout. Knowledge of such lesions and their imaging appearances on MRI evaluation is essential for a reader. Additionally, a systematic approach is important to accurately diagnose these lesions. In this article we discuss the various causes of spinal sclerotic lesions, describe their MRI characteristics with relevant case examples, and outline a systematic approach to their evaluation.
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336
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Zeichner SB, Cepeda J, Shukla R, Francavilla M, Hodzic E. Groin Pain Resulting From Spondylodiscitis. J Osteopath Med 2013; 113:796. [DOI: 10.7556/jaoa.2013.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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337
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Kim BN, Kim ES, Oh MD. Oral antibiotic treatment of staphylococcal bone and joint infections in adults. J Antimicrob Chemother 2013; 69:309-22. [DOI: 10.1093/jac/dkt374] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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338
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Microbiological diagnosis of vertebral osteomyelitis: relevance of second percutaneous biopsy following initial negative biopsy and limited yield of post-biopsy blood cultures. Eur J Clin Microbiol Infect Dis 2013; 33:371-5. [DOI: 10.1007/s10096-013-1965-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/21/2013] [Indexed: 12/19/2022]
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339
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Chaves RL, Chakraborty A, Benziger D, Tannenbaum S. Clinical and pharmacokinetic considerations for the use of daptomycin in patients with Staphylococcus aureus bacteraemia and severe renal impairment. J Antimicrob Chemother 2013; 69:200-10. [DOI: 10.1093/jac/dkt342] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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340
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Nathan ST, Crawford AH, Lykissas MG, Mangano FT. Severe Thoracic Kyphosis with Neuropathy in a Three-Year-Old Child: A Case Report. JBJS Case Connect 2013; 3:e77. [PMID: 29252616 DOI: 10.2106/jbjs.cc.l.00260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Senthil T Nathan
- Divisions of Orthopaedic Surgery (S.T.N., A.H.C., and M.G.L.) and Pediatric Neurosurgery (F.T.M.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2017, Cincinnati, OH 45229-3039.
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341
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Inoue S, Moriyama T, Horinouchi Y, Tachibana T, Okada F, Maruo K, Yoshiya S. Comparison of clinical features and outcomes of staphylococcus aureus vertebral osteomyelitis caused by methicillin-resistant and methicillin-sensitive strains. SPRINGERPLUS 2013; 2:283. [PMID: 23853753 PMCID: PMC3701790 DOI: 10.1186/2193-1801-2-283] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 06/19/2013] [Indexed: 12/18/2022]
Abstract
The causative organism of vertebral osteomyelitis (VO) was almost exclusively Staphylococcus aureus. The purpose of this study was to delineate the differences in clinical features and outcomes between patients with methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) VO. This study retrospectively reviewed 85 consecutive patients with VO treated between 2005 and 2011. Surgical site infections were excluded. Diagnosis was made by cultures of either blood or biopsied samples. We identified 16 cases of MRSA VO and 14 cases of MSSA VO. The average follow-up period was 18.5 months. Clinical features and outcomes were analyzed. Males were more likely to have MRSA VO than MSSA VO (87.5% vs. 35.7%). In regards to the number of co-morbidities, patients with MRSA VO had significantly more co-mobidities than patients with MSSA VO. Additionally, the rate of patients who underwent surgical procedure (excluding spinal surgeries in the affected region) within 3 months were significantly higher in the MRSA VO group than the MSSA VO group (56.3% vs. 14.3%). White blood cell counts and C-reactive protein levels in patients with both strains significantly improved 4 weeks after the initial treatment compared with the pretreatment values. The recurrence rate within 6 months tended to be higher for MRSA VO (37.5% vs. 7.1%), but no significant difference in mortality was observed between the two VO types. In conclusion, male sex, multiple co-morbidities and previous non-spine surgery were significant risk factors for VO due to MRSA as compared to MSSA. The recurrence rate within 6 months tended to be higher for MRSA VO. Patients with MRSA VO should be monitored carefully for recurrence by sequential clinical, radiographic, and laboratory examinations during the treatment course.
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Affiliation(s)
- Shinichi Inoue
- Departments of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501 Japan
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342
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Duarte RM, Vaccaro AR. Spinal infection: state of the art and management algorithm. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:2787-99. [PMID: 23756630 DOI: 10.1007/s00586-013-2850-1] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 05/11/2013] [Accepted: 06/01/2013] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Spinal infection is a rare pathology although a concerning rising incidence has been observed in recent years. This increase might reflect a progressively more susceptible population but also the availability of increased diagnostic accuracy. Yet, even with improved diagnosis tools and procedures, the delay in diagnosis remains an important issue. This review aims to highlight the importance of a methodological attitude towards accurate and prompt diagnosis using an algorithm to aid on spinal infection management. METHODS Appropriate literature on spinal infection was selected using databases from the US National Library of Medicine and the National Institutes of Health. RESULTS Literature reveals that histopathological analysis of infected tissues is a paramount for diagnosis and must be performed routinely. Antibiotic therapy is transversal to both conservative and surgical approaches and must be initiated after etiological diagnosis. Indications for surgical treatment include neurological deficits or sepsis, spine instability and/or deformity, presence of epidural abscess and upon failure of conservative treatment. CONCLUSIONS A methodological assessment could lead to diagnosis effectiveness of spinal infection. Towards this, we present a management algorithm based on literature findings.
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Affiliation(s)
- Rui M Duarte
- Orthopedic Surgery Department, Hospital de Braga, Sete Fontes-São Victor, 4710-243, Braga, Portugal,
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343
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Spinal infections with and without hardware: the viewpoint of an infectious disease specialist. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 23 Suppl 1:S21-8. [DOI: 10.1007/s00590-013-1239-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 05/15/2013] [Indexed: 10/26/2022]
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344
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Barrey C, Launay O, Freitas E, Michel F, Laurent F, Chidiac C, Perrin G, Ferry T. The follow-up of patients with postoperative infection of the spine. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 23 Suppl 1:S29-34. [DOI: 10.1007/s00590-013-1243-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 05/15/2013] [Indexed: 11/25/2022]
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346
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Abstract
Central nervous system (CNS) infections—i.e., infections involving the brain (cerebrum and cerebellum), spinal cord, optic nerves, and their covering membranes—are medical emergencies that are associated with substantial morbidity, mortality, or long-term sequelae that may have catastrophic implications for the quality of life of affected individuals. Acute CNS infections that warrant neurointensive care (ICU) admission fall broadly into three categories—meningitis, encephalitis, and abscesses—and generally result from blood-borne spread of the respective microorganisms. Other causes of CNS infections include head trauma resulting in fractures at the base of the skull or the cribriform plate that can lead to an opening between the CNS and the sinuses, mastoid, the middle ear, or the nasopharynx. Extrinsic contamination of the CNS can occur intraoperatively during neurosurgical procedures. Also, implanted medical devices or adjunct hardware (e.g., shunts, ventriculostomies, or external drainage tubes) and congenital malformations (e.g., spina bifida or sinus tracts) can become colonized and serve as sources or foci of infection. Viruses, such as rabies, herpes simplex virus, or polioviruses, can spread to the CNS via intraneural pathways resulting in encephalitis. If infection occurs at sites (e.g., middle ear or mastoid) contiguous with the CNS, infection may spread directly into the CNS causing brain abscesses; alternatively, the organism may reach the CNS indirectly via venous drainage or the sheaths of cranial and spinal nerves. Abscesses also may become localized in the subdural or epidural spaces. Meningitis results if bacteria spread directly from an abscess to the subarachnoid space. CNS abscesses may be a result of pyogenic meningitis or from septic emboli associated with endocarditis, lung abscess, or other serious purulent infections. Breaches of the blood–brain barrier (BBB) can result in CNS infections. Causes of such breaches include damage (e.g., microhemorrhage or necrosis of surrounding tissue) to the BBB; mechanical obstruction of microvessels by parasitized red blood cells, leukocytes, or platelets; overproduction of cytokines that degrade tight junction proteins; or microbe-specific interactions with the BBB that facilitate transcellular passage of the microorganism. The microorganisms that cause CNS infections include a wide range of bacteria, mycobacteria, yeasts, fungi, viruses, spirochaetes (e.g., neurosyphilis), and parasites (e.g., cerebral malaria and strongyloidiasis). The clinical picture of the various infections can be nonspecific or characterized by distinct, recognizable clinical syndromes. At some juncture, individuals with severe acute CNS infections require critical care management that warrants neuro-ICU admission. The implications for CNS infections are serious and complex and include the increased human and material resources necessary to manage very sick patients, the difficulties in triaging patients with vague or mild symptoms, and ascertaining the precise cause and degree of CNS involvement at the time of admission to the neuro-ICU. This chapter addresses a wide range of severe CNS infections that are better managed in the neuro-ICU. Topics covered include the medical epidemiology of the respective CNS infection; discussions of the relevant neuroanatomy and blood supply (essential for understanding the pathogenesis of CNS infections) and pathophysiology; symptoms and signs; diagnostic procedures, including essential neuroimaging studies; therapeutic options, including empirical therapy where indicated; and the perennial issue of the utility and effectiveness of steroid therapy for certain CNS infections. Finally, therapeutic options and alternatives are discussed, including the choices of antimicrobial agents best able to cross the BBB, supportive therapy, and prognosis.
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Affiliation(s)
- A Joseph Layon
- Pulmonary and Critical Care Medicine, Geisinger Health System, Danville, Pennsylvania USA
| | - Andrea Gabrielli
- Departments of Anesthesiology & Surgery, University of Florida College of Medicine, Gainesville, Florida USA
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347
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Akiyama T, Chikuda H, Yasunaga H, Horiguchi H, Fushimi K, Saita K. Incidence and risk factors for mortality of vertebral osteomyelitis: a retrospective analysis using the Japanese diagnosis procedure combination database. BMJ Open 2013; 3:bmjopen-2012-002412. [PMID: 23533214 PMCID: PMC3612742 DOI: 10.1136/bmjopen-2012-002412] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To examine the incidence of vertebral osteomyelitis (VO) and the clinical features of VO focusing on risk factors for death using a Japanese nationwide administrative database. DESIGN Retrospective observational study. SETTING Hospitals adopting the Diagnosis Procedure Combination system during 2007-2010. PARTICIPANTS We identified 7118 patients who were diagnosed with VO (International Classification of Diseases, 10th Revision codes: A18.0, M46.4, M46.5, M46.8, M46.9, M48.9 and M49.3, checked with the detailed diagnoses in each case and all other codes indicating the presence of a specific infection) and hospitalised between July and December, 2007-2010, using the Japanese Diagnosis Procedure Combination database. MAIN OUTCOME MEASURES The annual incidence of VO was estimated. Logistic regression analysis was performed to analyse factors affecting in-hospital mortality in the VO patients. Dependent variables included patient characteristics (age, sex and comorbidities), procedures (haemodialysis and surgery) and hospital factors (type of hospital and hospital volume). RESULTS Overall, 58.9% of eligible patients were men and the average age was 69.2 years. The estimated incidence of VO increased from 5.3/100 000 population per year in 2007 to 7.4/100 000 population per year in 2010. In-hospital mortality was 6%. There was a linear trend between higher rates of in-hospital mortality and greater age. A higher rate of in-hospital mortality was significantly associated with haemodialysis use (ORs, 10.56 (95% CI 8.12 to 13.74)), diabetes (2.37 (1.89 to 2.98)), liver cirrhosis (2.63 (1.49 to 4.63)), malignancy (2.68, (2.10 to 3.42)) and infective endocarditis (3.19 (1.80 to 5.65)). CONCLUSIONS Our study demonstrates an increasing incidence of VO, and defines risk factors for death with a nationwide database. Several comorbidities were significantly associated with higher rates of in-hospital death in VO patients.
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Affiliation(s)
- Toru Akiyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromasa Horiguchi
- Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Kazuo Saita
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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348
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Seaton RA, Malizos KN, Viale P, Gargalianos-Kakolyris P, Santantonio T, Petrelli E, Pathan R, Heep M, Chaves RL. Daptomycin use in patients with osteomyelitis: a preliminary report from the EU-CORE(SM) database. J Antimicrob Chemother 2013; 68:1642-9. [PMID: 23515247 PMCID: PMC3682689 DOI: 10.1093/jac/dkt067] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Osteomyelitis is a complex and heterogeneous group of infections that require surgical and antimicrobial interventions. Because treatment failure or intolerance is common, new treatment options are needed. Daptomycin has broad Gram-positive activity, penetrates bone effectively and has bactericidal activity within biofilms. This is the first report on clinical outcomes in patients with osteomyelitis from the multicentre, retrospective, non-interventional European Cubicin(®) Outcomes Registry and Experience (EU-CORE(SM)), a large database on real-world daptomycin use. PATIENTS AND METHODS In total, 220 patients were treated for osteomyelitis; the population was predominantly elderly, with predisposing baseline conditions such as diabetes and chronic renal/cardiac diseases. RESULTS Most patients (76%) received prior antibiotic treatment, and first-line treatment failure was the most frequent reason to start daptomycin. Common sites of infection were the knee (22%) or hip (21%), and the most frequently isolated pathogens were Staphylococcus aureus (33%) and coagulase-negative staphylococci (32%). Overall, 52% of patients had surgery, 55% received concomitant antibiotics and 29% received a proportion of daptomycin therapy as outpatients. Clinical success was achieved in 75% of patients. Among patients with prosthetic device-related osteomyelitis, there was a trend towards higher success rates if the device was removed. Daptomycin was generally well tolerated. CONCLUSIONS This analysis suggests that daptomycin is an effective and well-tolerated treatment option for osteomyelitis and highlights the importance of optimal surgical intervention and appropriate microbiological diagnosis for clinical outcomes.
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349
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Chest pain? An unusual presentation of vertebral osteomyelitis. Case Rep Med 2013; 2013:416498. [PMID: 23476664 PMCID: PMC3582057 DOI: 10.1155/2013/416498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 01/09/2013] [Accepted: 01/11/2013] [Indexed: 12/17/2022] Open
Abstract
We present a case of vertebral osteomyelitis presenting as chest pain. The patient initially underwent a CT chest angiogram to rule out a pulmonary embolism, which incidentally showed a soft tissue vertebral mass at T3-T4 disk space. Subsequent thoracic vertebral MRI was consistent with osteomyelitis with cord compression. Tissue culture from a CT-guided biopsy grew MRSA. The patient was successfully treated with Vancomycin. This is a rare presentation of vertebral osteomyelitis which poses an interesting diagnostic challenge.
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350
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Abstract
Osteomyelitis is an inflammatory bone disorder caused by infection, leading to necrosis and destruction of bone. It can affect all ages, involve any bone, become a chronic disease and cause persistent morbidity. Treatment of osteomyelitis is challenging particularly when complex multiresistant bacterial biofilm has already been established. Bacteria in biofilm persist in a low metabolic phase, causing persistent infection due to increased resistance to antibiotics. Staphylococcus aureus and Staphylococcus epidermidis are the most common causative organism responsible for more than 50% of osteomyelitis cases. Osteomyelitis treatment implies the administration of high doses of antibiotics (AB) by means of endovenous and oral routes and should take a period of at least 6 weeks. Local drug delivery systems, using non-biodegradable (polymethylmethacrylate) or biodegradable and osteoactive materials such as calcium orthophosphates bone cements, have been shown to be promising alternatives for the treatment of osteomyelitis. These systems allow the local delivery of AB in situ with bactericidal concentrations for long periods of time and without the toxicity associated with other means of administration. This review examines the most recent literature evidence on the causes, pathogeneses and pharmacological treatment of osteomyelitis. The study methodology consisted of a literature review in Google Scholar, Science Direct, Pubmed, Springer link, B-on. Papers from 1979 till present were reviewed and evaluated.
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