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Yang CC, Lee MH, Liu CY, Lin MH, Yang YH, Chen KT, Huang TY. The IFSD Score-A Practical Prognostic Model for Invasive Fungal Spondylodiscitis. J Fungi (Basel) 2024; 10:61. [PMID: 38248971 PMCID: PMC10819940 DOI: 10.3390/jof10010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Objectives: Invasive fungal spondylodiscitis (IFSD) is rare and could be lethal in certain circumstances. The previous literature revealed limited data concerning its outcomes. This study aimed to establish a risk-scoring system to predict the one-year mortality rate of this disease. Methods: A total of 53 patients from a multi-centered database in Taiwan were included in this study. All the clinicopathological and laboratory data were retrospectively analyzed. Variables strongly related to one-year mortality were identified using a multivariate Cox proportional hazards model. A receiver operating characteristic (ROC) curve was used to express the performance of our IFSD scoring model. Results: Five strong predictors were included in the IFSD score: predisposing immunocompromised state, the initial presentation of either radiculopathy or myelopathy, initial laboratory findings of WBC > 12.0 or <0.4 103/µL, hemoglobin < 8 g/dL, and evidence of candidemia. One-year mortality rates for patients with IFSD scores of 0, 1, 2, 3, and 4 were 0%, 16.7%, 56.3%, 72.7%, and 100%, respectively. The area under the curve of the ROC curve was 0.823. Conclusions: We developed a practical scoring model with easily obtained demographic, clinical, and laboratory parameters to predict the probability of one-year mortality in patients with IFSD. However, more large-scale and international validations would be necessary before this scoring model is commonly used.
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Affiliation(s)
- Chao-Chun Yang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-C.Y.); (M.-H.L.); (K.-T.C.)
| | - Ming-Hsueh Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-C.Y.); (M.-H.L.); (K.-T.C.)
| | - Chia-Yen Liu
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-Y.L.); (M.-H.L.); (Y.-H.Y.)
| | - Meng-Hung Lin
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-Y.L.); (M.-H.L.); (Y.-H.Y.)
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-Y.L.); (M.-H.L.); (Y.-H.Y.)
- School of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Kuo-Tai Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan; (C.-C.Y.); (M.-H.L.); (K.-T.C.)
| | - Tsung-Yu Huang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan
- Microbiology Research and Treatment Center, Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
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Oliva A, De Rosa FG, Mikulska M, Pea F, Sanguinetti M, Tascini C, Venditti M. Invasive Candida infection: epidemiology, clinical and therapeutic aspects of an evolving disease and the role of rezafungin. Expert Rev Anti Infect Ther 2023; 21:957-975. [PMID: 37494128 DOI: 10.1080/14787210.2023.2240956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Invasive Candida Infections (ICIs) have undergone a series of significant epidemiological, pathophysiological, and clinical changes during the last decades, with a shift toward non-albicans species, an increase in the rate of exogenous infections and clinical manifestations ranging from candidemia to an array of highly invasive and life-threatening clinical syndromes. The long-acting echinocandin rezafungin exhibits potent in-vitro activity against most wild-type and azole-resistant Candida spp. including C.auris. AREAS COVERED The following topics regarding candidemia only and ICIs were reviewed and addressed: i) pathogenesis; ii) epidemiology and temporal evolution of Candida species; iii) clinical approach; iv) potential role of the novel long-acting rezafungin in the treatment of ICIs. EXPERT OPINION Authors' expert opinion focused on considering the potential role of rezafungin in the evolving context of ICIs. Rezafungin, which combines a potent in-vitro activity against Candida species, including azole-resistant strains and C.auris, with a low likelihood of drug-drug interactions and a good safety profile, may revolutionize the treatment of candidemia/ICI. Indeed, it may shorten the length of hospital stays when clinical conditions allow and extend outpatient access to treatment of invasive candidiasis, especially when prolonged treatment duration is expected.
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Affiliation(s)
- Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, University of Turin, Infectious Diseases, City of Health and Sciences, Turin, Italy
| | - Malgorzata Mikulska
- Division of Infectious Diseases Department of Health Sciences (DISSAL), University of Genoa IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Maurizio Sanguinetti
- Department of Laboratory Sciences and Infectious Diseases, Fondazione Policlinico Universitario "A. Gemelli"; IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Carlo Tascini
- Infectious Diseases Clinic: Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Lucasti C, Scott MM, Vallee EK, Kowalski J. Intradural Candida Albicans infection that presented as epidural abscess: A case report. Int J Surg Case Rep 2023; 107:108337. [PMID: 37210802 DOI: 10.1016/j.ijscr.2023.108337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 05/23/2023] Open
Abstract
INTRODUCTION Intradural Candida Albicans infections are rare with limited number of reports on the pathological condition. Among these reports, patients with these infections had radiographic evidence supporting an intradural infection diagnosis. In this case, the patient displayed radiographic imaging suggestive of an epidural infection, but surgery revealed the infection to be intradural. This case exemplifies the importance of considering intradural infections in future cases of suspected epidural abscesses and highlights antibiotic management of intradural C. albicans infections. PRESENTATION OF CASE A incarcerated 26-year-old male presented with a rare Candida Albicans infection. He arrived at the hospital unable to walk, and radiographic imaging was consistent with a thoracic epidural abscess. Due to his severe neurologic deficit and spreading edema, surgical intervention was required and revealed no signs of epidural infection. Incision of the dura revealed a purulent material cultured as C. albicans. After six weeks, the intradural infection returned and the patient required another surgery. This operation helped prevent further motor function loss. DISCUSSION When patients present with a progressive neurologic deficit and radiographic evidence indicative of an epidural abscess, it is important for surgeons to be mindful of a possible intradural infection. If no abscess is found in the epidural space during surgery, opening the dura in patients with worsening neurologic symptoms must be considered to rule out an intradural infection. CONCLUSION Preoperative suspicion of an epidural abscess can differ from intraoperative diagnosis and looking intradural for an infection can prevent further motor loss.
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Affiliation(s)
- Christopher Lucasti
- UBMD Orthopaedics and Sports Medicine Doctors Buffalo, Buffalo, NY, United States of America
| | - Maxwell M Scott
- Jacobs School of Medicine and Biomedical Sciences Buffalo, NY, United States of America
| | - Emily K Vallee
- Jacobs School of Medicine and Biomedical Sciences Buffalo, NY, United States of America.
| | - Joseph Kowalski
- UBMD Orthopaedics and Sports Medicine Doctors Buffalo, Buffalo, NY, United States of America
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Candura D, Perna A, Calori S, Tamburrelli FC, Proietti L, Meluzio MC, Velluto C, Smakaj A, Santagada DA. Vertebral Candidiasis, the State of the Art: A Systematic Literature Review. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:231-240. [PMID: 38153475 DOI: 10.1007/978-3-031-36084-8_36] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVE In recent years, Candida spondylodiscitis has represented an increasingly emerging disease in clinical practice. This condition requires long-term antibiotic therapy and sometimes surgical treatments. The main purpose of this study is to investigate the epidemiology, clinical and radiological aspects, treatment protocols, and outcomes of Candida-mediated vertebral osteomyelitis. METHODS A systematic review of the English literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.The research was conducted on Medline, Cochrane library, PubMed, and Scopus using as search terms "vertebral"; "spinal"; "infection"; "spondylodiscitis"; "discitis"; "osteomyelitis"; "Candida"; and "Candidosis." A case of vertebral candidiasis that was surgically managed was also reported. RESULTS In total, 88 articles were included in our systematic review. Including the reported case, our analysis covered 113 cases of vertebral candidiasis. Candida albicans was isolated in 64 cases (56.1%), Candida tropicalis in 21 (18.4%), Candida glabrata in 14 (12.3%), and Candida parapsilosis in five (4.4%). The mean duration of the follow-up was 395 days. Finally, 87 (82%) patients completely recovered, ten (9.4%) died, and nine (8.5%) reported sequelae. CONCLUSION This systematic review summarized the state of the art on vertebral candidiasis, describing data on its clinical features, diagnostic criteria and current limitations, and treatment alternatives and their outcomes.
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Affiliation(s)
- Dario Candura
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Andrea Perna
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Orthopedics and Traumatology, Fondazione Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Rome, Italy
| | - Sara Calori
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Geriatrics and Orthopedics, Sacred Heart Catholic University, Rome, Italy
| | - Luca Proietti
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Geriatrics and Orthopedics, Sacred Heart Catholic University, Rome, Italy
| | - Maria Concetta Meluzio
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Calogero Velluto
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Amarildo Smakaj
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Domenico Alessandro Santagada
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
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Di Bari S, Gavaruzzi F, De Meo D, Cera G, Raponi G, Ceccarelli G, Villani C. Candida parapsilosis osteomyelitis following dog bite: a case report and review of the literature. J Mycol Med 2021; 32:101208. [PMID: 34758425 DOI: 10.1016/j.mycmed.2021.101208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/28/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Abstract
Candida osteomyelitis is uncommon, especially after dog bites. We describe a case of a 63-year-old man without significant comorbidities presenting progressing swelling of the distal interphalangeal joint (DIJ) of right index finger following a dog bite. Despite empiric antibiotic therapy and local medications, there were no clinical signs of improvement. Clinical examination revealed fistula with purulent drainage on the volar region. Even though laboratory data showed inflammatory markers on range, magnetic resonance imaging (MRI) demonstrated signs of osteomyelitis. The patient was taken to exploration and debridement of the bite wound. Culture of the bone biopsy showed growth of Candida parapsilosis. Therefore, the patient was diagnosed with isolated fungal osteomyelitis and was initiated on fluconazole therapy. The treatment was effective and all symptoms were resolved in 8 weeks after the surgery. There were no signs of recurrence after 20 months of follow-up. The patient had no cosmetic abnormalities or sequelae. Concurrently with the description of the case report a review of the literature was provided. According to the authors, there are three main etiopathogenesis for this infection. The first pathogenic mechanism is direct inoculation into the deep tissues through the dog bite. The second hypothesis is direct translocation of the pathogen from the skin to the deep tissue and to the bone. The last mode of transmission is hematogenous dissemination. Fungal osteomyelitis are really rare conditions, especially after dog bites, but nevertheless it should be considered as a possible diagnosis when there is no response to antibiotics.
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Affiliation(s)
- Silvia Di Bari
- Department of Public Health and Infectious Diseases "Sapienza", University of Rome, Viale del Policlinico 155, Rome, Italy; M.I.T.O. Group (Infectious Diseases in Traumatology and Orthopedics Surgery), Policlinico Umberto I, University Hospital, Viale del Policlinico, 155, 00161 Rome, Italy
| | - Francesca Gavaruzzi
- Department of Public Health and Infectious Diseases "Sapienza", University of Rome, Viale del Policlinico 155, Rome, Italy; M.I.T.O. Group (Infectious Diseases in Traumatology and Orthopedics Surgery), Policlinico Umberto I, University Hospital, Viale del Policlinico, 155, 00161 Rome, Italy
| | - Daniele De Meo
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, University of Rome, Viale del Policlinico 155, Rome, Italy; M.I.T.O. Group (Infectious Diseases in Traumatology and Orthopedics Surgery), Policlinico Umberto I, University Hospital, Viale del Policlinico, 155, 00161 Rome, Italy
| | - Gianluca Cera
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, University of Rome, Viale del Policlinico 155, Rome, Italy; M.I.T.O. Group (Infectious Diseases in Traumatology and Orthopedics Surgery), Policlinico Umberto I, University Hospital, Viale del Policlinico, 155, 00161 Rome, Italy
| | - Giammarco Raponi
- Department of Public Health and Infectious Diseases "Sapienza", University of Rome, Viale del Policlinico 155, Rome, Italy; M.I.T.O. Group (Infectious Diseases in Traumatology and Orthopedics Surgery), Policlinico Umberto I, University Hospital, Viale del Policlinico, 155, 00161 Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases "Sapienza", University of Rome, Viale del Policlinico 155, Rome, Italy; M.I.T.O. Group (Infectious Diseases in Traumatology and Orthopedics Surgery), Policlinico Umberto I, University Hospital, Viale del Policlinico, 155, 00161 Rome, Italy.
| | - Ciro Villani
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, University of Rome, Viale del Policlinico 155, Rome, Italy; M.I.T.O. Group (Infectious Diseases in Traumatology and Orthopedics Surgery), Policlinico Umberto I, University Hospital, Viale del Policlinico, 155, 00161 Rome, Italy
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Acar E, Bezirgan U. A rare cause of osteomyelitis of distal phalanx: Candida lusitaniae. Jt Dis Relat Surg 2021; 32:556-559. [PMID: 34145840 PMCID: PMC8343857 DOI: 10.52312/jdrs.2021.79490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/08/2020] [Indexed: 11/25/2022] Open
Abstract
Osteomyelitis of the phalanx caused by Candida species are rare. A 49-year-old female patient was admitted to an external center with a splinter injury of the third phalanx of the middle finger of her left hand about 45 days ago. She was referred to our clinic with persistent pain and discharge, despite four-week antibiotherapy. Debridement and curettage were performed and partial excision of the distal phalanx at an appropriate level was done. Her complaints gradually resolved postoperatively with prescribed antibiotics for the pathogen identified as Candida lusitaniae based on the intraoperative cultures. At her three-month follow-up visit, treatment yielded near-excellent results. To the best of our knowledge, this is the first case of osteomyelitis of the distal phalanx caused by Candida lusitaniae in the literature, highlighting the importance of definitive diagnosis and pathogen-specific treatment, rather than empirical treatment, to achieve favorable results with cure.
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Affiliation(s)
- Erdinc Acar
- Department of Orthopedics and Traumatology, Hand and Upper Extremity Surgery Division, Ankara City Hospital, Ankara, Turkey
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Overgaauw AJC, de Leeuw DC, Stoof SP, van Dijk K, Bot JCJ, Hendriks EJ. Case report: Candida krusei spondylitis in an immunocompromised patient. BMC Infect Dis 2020; 20:739. [PMID: 33032533 PMCID: PMC7542866 DOI: 10.1186/s12879-020-05451-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 09/24/2020] [Indexed: 11/17/2022] Open
Abstract
Background Invasive infections with Candida krusei are uncommon and rarely complicated by spondylitis. Previous described cases were solely treated with antimycotic therapy, despite guidelines recommending surgical interventions. Case presentation We describe a case of C. krusei spondylitis in a patient treated with chemotherapy for acute myeloid leukemia. After induction chemotherapy, the patient developed a candidemia, which was treated with micafungin. One month after the candidemia, the patient was admitted with severe lumbar pain. Spondylitis of the L4 and L5 vertebra was diagnosed on MR-imaging, with signs suggesting an atypical infection. The patient was treated with anidulafungin combined with voriconazole. Despite maximal conservative management symptoms gradually worsened eventually requiring surgical intervention. Conclusions In contrast to previous case reports, antimycotic treatment alone could be insufficient in treating C. krusei spondylitis.
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Affiliation(s)
- Audrey J C Overgaauw
- Department of Internal Medicine, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands.
| | - David C de Leeuw
- Department of Hematology, Cancer Center Amsterdam (CCA), Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands
| | - Susanne P Stoof
- Department of Medical Microbiology, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands
| | - Karin van Dijk
- Department of Medical Microbiology, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands
| | - Joost C J Bot
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands
| | - Eef J Hendriks
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands
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Ishak B, Abdul-Jabbar A, Moss GB, Yilmaz E, von Glinski A, Frieler S, Unterberg AW, Blecher R, Altafulla J, Roh J, Hart RA, Oskouian RJ, Chapman JR. De novo methicillin-resistant Staphylococcus aureus vs. methicillin-sensitive Staphylococcus aureus infections of the spine, similar clinical outcome, despite more severe presentation in surgical patients. Neurosurg Rev 2020; 44:2111-2118. [PMID: 32851541 DOI: 10.1007/s10143-020-01376-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/18/2020] [Accepted: 08/20/2020] [Indexed: 11/28/2022]
Abstract
Vertebral osteomyelitis (VO) is a severe infection of the vertebral body and the adjacent disc space, where Staphylococcus aureus is most commonly isolated. The objective of this retrospective study was to determine risk factors for and compare outcome differences between de novo methicillin-resistant Staphylococcus aureus (MRSA) VO and methicillin-sensitive Staphylococcus aureus (MSSA) VO. A retrospective cohort study was performed by review of the electronic medical records of 4541 consecutive spine surgery patients. Among these 37 underwent surgical treatment of de novo MRSA and MSSA spinal infections. Patient demographics, pre- and postoperative neurological status (ASIA impairment score), surgical treatment, inflammatory laboratory values, nutritional status, comorbidities, antibiotics, hospital stay, ICU stay, reoperation, readmission, and complications were collected. A minimum follow-up (FU) of 12 months was required. Among the 37 patients with de novo VO, 19 were MRSA and 18 were MSSA. Mean age was 52.4 and 52.9 years in the MRSA and MSSA groups, respectively. Neurological deficits were found in 53% of patients with MRSA infection and in 17% of the patients with MSSA infection, which was statistically significant (p < 0.05). Chronic renal insufficiency and malnutrition were found to be significant risk factors for MRSA VO. Preoperative albumin was significantly lower in the MRSA group (p < 0.05). Patients suffering from spinal infection with chronic renal insufficiency and malnutrition should be watched more carefully for MRSA. The MRSA group did not show a significant difference with regard to final clinical outcome despite more severe presentation.
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Affiliation(s)
- Basem Ishak
- Swedish Neuroscience Institute, Seattle, WA, USA. .,Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany.
| | | | - Gregory B Moss
- Department of Infectious Disease, Swedish Medical Center, Seattle, WA, USA
| | - Emre Yilmaz
- Swedish Neuroscience Institute, Seattle, WA, USA.,Department of Trauma Surgery, BG University Hospital Bochum, Bochum, Germany
| | - Alexander von Glinski
- Swedish Neuroscience Institute, Seattle, WA, USA.,Department of Trauma Surgery, BG University Hospital Bochum, Bochum, Germany
| | - Sven Frieler
- Swedish Neuroscience Institute, Seattle, WA, USA.,Department of Trauma Surgery, BG University Hospital Bochum, Bochum, Germany
| | - Andreas W Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | | | | | - Jeffrey Roh
- Swedish Neuroscience Institute, Seattle, WA, USA
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Pesch S, Hanschen M, Greve F, Zyskowski M, Seidl F, Kirchhoff C, Biberthaler P, Huber-Wagner S. Treatment of fracture-related infection of the lower extremity with antibiotic-eluting ceramic bone substitutes: case series of 35 patients and literature review. Infection 2020; 48:333-344. [PMID: 32270441 PMCID: PMC7256080 DOI: 10.1007/s15010-020-01418-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/26/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The current treatment concepts of fracture-related infection (FRI) [Consensus Conference (Anti-Infection Task Force (AITF)) on the definition of acute or chronic osteomyelitis (cOM)] are associated with unsolved challenges and problems, underlining the need for ongoing medical research. METHOD Literature review of treatments for FRI and description of own cases. RESULTS We could include eight papers with 394 patients reporting treatments and outcome in FRI. The infection was resolved in 92.9% (mean) of all treatments. The mean follow-up was 25 months with a persistent non-union in 7% of the patients. We diagnosed 35 (19f/16m; 56.4 ± 18.6 years) patients with bone infections anatomically allocated to the proximal and distal femur (12×), the pelvis (2×), distal tibia (3×), tibial diaphysis (11×), the ankle joint (4×) and calcaneus (3×). These 35 patients were treated (1) with surgical debridement; (2) with antibiotic-eluting ceramic bone substitutes; (3) bone stabilization (including nail fixation, arthrodesis nails, plates, or external ring fixation), (4) optionally negative pressure wound therapy (NPWT) and (5) optionally soft tissue closure with local or free flaps. The mean follow-up time was 14.9 ± 10.6 months (min/max: 2/40 month). The overall recurrence rate is low (8.5%, 3/35). Prolonged wound secretion was observed in six cases (17.1%, 6/35). The overall number of surgeries was a median of 2.5. CONCLUSION The results in the literature and in our case series are explicitly promising regarding the treatment of posttraumatic fracture-related infection.
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Affiliation(s)
- Sebastian Pesch
- Department of Trauma Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Marc Hanschen
- Department of Trauma Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Frederik Greve
- Department of Trauma Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Michael Zyskowski
- Department of Trauma Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Fritz Seidl
- Department of Trauma Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stefan Huber-Wagner
- Department of Trauma Surgery, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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10
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Welcome to our new Section Editors in INFECTION. Infection 2020; 48:1-2. [DOI: 10.1007/s15010-019-01387-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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