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Cui Y, Wang Q, Mi C, Wang B, Pan Y, Lin Y, He R, Sun L, Zheng B, Shi X. Peking University First Hospital Procedure for Culturing Pathogenic Microorganisms for Bone and Joint Infection. Infect Drug Resist 2024; 17:3173-3183. [PMID: 39070717 PMCID: PMC11277841 DOI: 10.2147/idr.s464350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024] Open
Abstract
Background This retrospective cohort study explores a practical approach to acquiring pathogenic microorganisms in patients with bone and joint infections. Methods From Aug 2018 to Mar 2022, 68 consecutive patients (87 cultures) with bone and joint infection were recruited in this study. All cultures followed the Peking University First Hospital Procedure of Culturing Pathogenic microorganisms for bone and joint infection. Tissue samples were obtained through fluoroscopy-guided biopsy or open debridement. Tissue samples were divided into manual homogenization (MH), manual mixture (MM), and pathological examination. The baseline, antibiotic exposure, laboratory, surgical, and microbial data were reviewed. Independent sample T-test, Mann-Whitney U-test, and Chi-square test were used to detect the difference between patients who received different processing measures. Results The average age was 55.8±2.4 years old. Thirty-nine patients were male. The total positive culture rate of the manual homogenization group was 80.5% (70/87). Thirty-five patients had mixed infections with more than one microorganism cultured. Staphylococci accounted for 60.23% of all microorganisms. Staphylococcus aureus (18.2%) and Staphylococcus epidermidis (15.9%) were the two most common bacteria cultured in this study. Patients with positive culture in the manual mixture group had significantly higher WBC (p = 0.006), NE% (p = 0.024), ESR (p = 0.003), CRP (p = 0.020) and IL6 (0.050) compared to patients with negative culture. After tissue homogenization, only ESR is still statistically different. Patients without SIRS had a low positive culture rate (59.4%). Tissue homogenization could significantly increase the positive culture rate of patients without SIRS. Pre-culture antibiotic exposure was not an independent risk factor for culture results. Conclusion Peking University First Hospital Procedure for Culturing Pathogenic microorganisms for Bone and Joint Infections was a practical approach for obtaining pathogenic microorganisms.
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Affiliation(s)
- Yunpeng Cui
- Department of Orthopaedics, Peking University First Hospital, Beijing, People’s Republic of China
| | - Qiwei Wang
- Department of Orthopaedics, Peking University First Hospital, Beijing, People’s Republic of China
| | - Chuan Mi
- Department of Orthopaedics, Peking University First Hospital, Beijing, People’s Republic of China
| | - Bing Wang
- Department of Orthopaedics, Peking University First Hospital, Beijing, People’s Republic of China
| | - Yuanxing Pan
- Department of Orthopaedics, Peking University First Hospital, Beijing, People’s Republic of China
| | - Yunfei Lin
- Department of Orthopaedics, Peking University First Hospital, Beijing, People’s Republic of China
| | - Rui He
- Department of Plastic Surgery and Burn, Peking University First Hospital, Beijing, People’s Republic of China
| | - Liying Sun
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, People’s Republic of China
| | - Bo Zheng
- Department of Clinical Pharmacology, Peking University First Hospital, Beijing, People’s Republic of China
| | - Xuedong Shi
- Department of Orthopaedics, Peking University First Hospital, Beijing, People’s Republic of China
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Hijazi MM, Siepmann T, El-Battrawy I, Aweimer A, Engellandt K, Podlesek D, Schackert G, Juratli TA, Eyüpoglu IY, Filis A. Diagnostics, Management, and Outcomes in Patients with Pyogenic Spinal Intra- or Epidural Abscess. J Clin Med 2023; 12:7691. [PMID: 38137760 PMCID: PMC10744009 DOI: 10.3390/jcm12247691] [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: 11/23/2023] [Revised: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Owing to the lack of evidence on the diagnostics, clinical course, treatment, and outcomes of patients with extremely rare spinal intradural abscess (SIA) and spinal epidural abscess (SEA), we retrospectively analyzed and compared a cohort of patients to determine the phenotyping of both entities. METHODS Over a period of 20 years, we retrospectively analyzed the electronic medical records of 78 patients with SIA and SEA. RESULTS The patients with SIA showed worse motor scores (MS scores) on admission (SIA: 20 ± 26 vs. SEA: 75 ± 34, p < 0.001), more often with an ataxic gait (SIA: 100% vs. SEA: 31.8%, p < 0.001), and more frequent bladder or bowel dysfunction (SIA: 91.7% vs. SEA: 27.3%, p < 0.001) compared to the SEA patients. Intraoperative specimens showed a higher diagnostic sensitivity in the SEA patients than the SIA patients (SIA: 66.7% vs. SEA: 95.2%, p = 0.024), but various pathogens such as Staphylococcus aureus (SIA 33.3% vs. SEA: 69.4%) and Streptococci and Enterococci (SIA 33.3% vs. SEA: 8.1%, p = 0.038) were detected in both entities. The patients with SIA developed sepsis more often (SIA: 75.0% vs. SEA: 18.2%, p < 0.001), septic embolism (SIA: 33.3% vs. SEA: 8.3%, p = 0.043), signs of meningism (SIA: 100% vs. 18.5%, p < 0.001), ventriculitis or cerebral abscesses (SIA: 41.7% vs. SEA: 3.0%, p < 0.001), and pneumonia (SIA: 58.3% vs. SEA: 13.6%, p = 0.002). The mean MS score improved in both patient groups after surgery (SIA: 20 to 35 vs. SEA: 75 to 90); however, the SIA patients showed a poorer MS score at discharge (SIA: 35 ± 44 vs. SEA: 90 ± 20, p < 0.001). C-reactive protein (CrP) (SIA: 159 to 49 vs. SEA: 189 to 27) and leukocyte count (SIA: 15 to 9 vs. SEA: 14 to 7) were reduced at discharge. The SIA patients had higher rates of disease-related mortality (SIA: 33.3% vs. SEA: 1.5%, p = 0.002), had more pleural empyema (SIA: 58.3% vs. SEA: 13.6%, p = 0.002), required more than one surgery (SIA: 33.3% vs. SEA 13.6%, p = 0.009), were treated longer with intravenous antibiotics (7 ± 4 w vs. 3 ± 2 w, p < 0.001) and antibiotics overall (12 ± 10 w vs. 7 ± 3 w, p = 0.022), and spent more time in the hospital (SIA: 58 ± 36 vs. SEA: 26 ± 20, p < 0.001) and in the intensive care unit (SIA: 14 ± 18 vs. SEA: 4 ± 8, p = 0.002). CONCLUSIONS Our study highlighted distinct clinical phenotypes and outcomes between both entities, with SIA patients displaying a markedly less favorable disease course in terms of complications and outcomes.
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Affiliation(s)
- Mido Max Hijazi
- Department of Neurosurgery, Division of Spine Surgery, Faculty of Medicine, Technische Universität Dresden, University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307 Dresden, Germany; (D.P.); (G.S.); (T.A.J.); (I.Y.E.); (A.F.)
| | - Timo Siepmann
- Department of Neurology, Faculty of Medicine, Technische Universität Dresden, University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307 Dresden, Germany;
| | - Ibrahim El-Battrawy
- Department of Cardiology, Bergmannsheil University Hospital, Ruhr University Bochum, Bürkle De La Camp-Platz 1, 44789 Bochum, Germany; (I.E.-B.); (A.A.)
| | - Assem Aweimer
- Department of Cardiology, Bergmannsheil University Hospital, Ruhr University Bochum, Bürkle De La Camp-Platz 1, 44789 Bochum, Germany; (I.E.-B.); (A.A.)
| | - Kay Engellandt
- Institute of Diagnostic and Interventional Neuroradiology, Faculty of Medicine, Technische Universität Dresden, University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307 Dresden, Germany;
| | - Dino Podlesek
- Department of Neurosurgery, Division of Spine Surgery, Faculty of Medicine, Technische Universität Dresden, University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307 Dresden, Germany; (D.P.); (G.S.); (T.A.J.); (I.Y.E.); (A.F.)
| | - Gabriele Schackert
- Department of Neurosurgery, Division of Spine Surgery, Faculty of Medicine, Technische Universität Dresden, University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307 Dresden, Germany; (D.P.); (G.S.); (T.A.J.); (I.Y.E.); (A.F.)
| | - Tareq A. Juratli
- Department of Neurosurgery, Division of Spine Surgery, Faculty of Medicine, Technische Universität Dresden, University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307 Dresden, Germany; (D.P.); (G.S.); (T.A.J.); (I.Y.E.); (A.F.)
| | - Ilker Y. Eyüpoglu
- Department of Neurosurgery, Division of Spine Surgery, Faculty of Medicine, Technische Universität Dresden, University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307 Dresden, Germany; (D.P.); (G.S.); (T.A.J.); (I.Y.E.); (A.F.)
| | - Andreas Filis
- Department of Neurosurgery, Division of Spine Surgery, Faculty of Medicine, Technische Universität Dresden, University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307 Dresden, Germany; (D.P.); (G.S.); (T.A.J.); (I.Y.E.); (A.F.)
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