332. Spinal Infections: Clinical and Microbiological Characteristics in our Urban Referral Health Center

Abstract Background There has been an increasing trend in spinal infections (SI) in the U.S. over recent years. We sought to characterize the clinical and microbiological characteristics of SI at our hospital. Methods We conducted a retrospective review of SI over a 3-year period (2016 - 2019) utilizing ICD codes for data retrieval. Search terms included vertebral osteomyelitis, discitis, and epidural abscess. SPSS was used to compute the data. Results Of the initially screened 254 patients, 166 were included for analysis. Pertinent demographics were: mean age 59 years, male (61.4%), obese (44.5%), diabetic (25%), and drug-users (20%). Lumbosacral involvement was most common (69.8%); epidural abscess was present in 51.8% of patients. 15.7% had existing hardware. Overall, 79.5% (132/166) of cases had a positive culture from at least one site: blood 56.6% (94/166), CT-guided 83.5% (56/67), and surgical 51.1% (24/47). Of those patients with negative blood cultures, 22% (16/72) had pathogen recovery by CT-guided methods and 33% (24/72) from surgical specimens. S aureus was the most common pathogen isolated at 53.7% (71/132): MSSA comprised 38.6% (51/132) and MRSA 15.2% (20/132). The mean CRP (8.46 vs 15.83 mg/dL; P< 0.001), and WBC (9.08 vs 13.18 k/mcL; P< 0.001) were higher in culture-positive as compared to culture-negative cases. Mean ESR and temperature more than 100.4 oF did not differ significantly between these two groups. The 8-week median recurrence rate was 11.4%, of which nearly half had index S aureus bacteremia. Frequency of organisms isolated Association of mean inflammatory markers with positive cultures Conclusion Our study affirmed that S aureus is the most common cause of SI, of which MSSA was predominant. Epidural abscess was encountered in a substantial fraction of our case population. Leukocytosis and elevated CRP tended to predict culture-positive infection, whereas ESR and fever did not. As recommended in the IDSA Vertebral Osteomyelitis guidelines, blood cultures were obtained in all cases, which yielded positive results in more than half of patients. Pathogen recovery was further improved to nearly 80% with supplemental deep tissue sampling, thus highlighting the opportunity to enhance microbiological diagnosis at our institution. Disclosures All Authors: No reported disclosures

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Antimicrobial therapy and assessing therapeutic response in culture-negative pyogenic vertebral osteomyelitis: a retrospective comparative study with culture-positive pyogenic vertebral osteomyelitis

BMC Infectious Diseases ◽

10.1186/s12879-020-05669-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Dongwoo Yu ◽

Sang Woo Kim ◽

Ikchan Jeon

Keyword(s):

Back Pain ◽

Therapeutic Response ◽

Epidural Abscess ◽

Vertebral Osteomyelitis ◽

Bacterial Identification ◽

Oral Antibiotics ◽

Normal Range ◽

Pyogenic Vertebral Osteomyelitis ◽

Culture Positive ◽

Culture Negative

Abstract Background There are still controversies regarding the treatment and outcomes in culture-negative pyogenic vertebral osteomyelitis (PVO). The purpose of this study is to investigate the antimicrobial therapy, assessment of therapeutic response, and outcome of culture-negative PVO compared to culture-positive PVO. Methods A retrospective study was performed with non-surgical lumbar PVO patients. The patients were divided into two groups based on the causative bacterial identification (CN group with culture-negative PVO and CP group with culture-positive PVO). The clinical features, use of antibiotics, laboratory data, and outcomes were compared between the two groups. Results Seventy-three patients with 41 (56.2%) of the CN group and 32 (43.8%) of the CP group were enrolled. The CN group showed a shorter duration of parenteral antibiotics (45.88 ± 16.14 vs. 57.31 ± 24.39, p = 0.019) but a tendency of prolonged duration of total (parenteral + oral) antibiotics (101.17 ± 52.84 vs. 84.19 ± 50.29 days, p = 0.168). When parenteral antibiotics were discontinued or switched to oral antibiotics, the mean erythrocyte segmentation rate (ESR, normal range: < 25 mm/h), C-reactive protein (CRP, normal range: < 0.5 mg/dL) level, and visual analog scale (VAS) score of back pain were 42.86 ± 24.05 mm/h, 0.91 ± 1.18 mg/dL, and 4.05 ± 1.07, respectively, with no significant differences between the two groups. The recurrence rates of CN and CP groups were 7.3% (3/41) and 6.3% (2/32), respectively (p = 1.000). The presence of epidural abscess was the most significant factor for the identification of causative bacteria (p = 0.002), and there was no significant relationship between the use of empirical antibiotics before tissue culture and the causative bacterial identification (p = 0.194). Conclusions The CN group required a shorter duration of parenteral antibiotics than the CP group. Discontinuation of parenteral antibiotics or changing the administration route can be considered based on the values of ESR, CRP, and VAS score of back pain. The presence of epidural abscess was the most significant factor for the identification of causative bacteria.

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Antimicrobial therapy and assessing therapeutic response in culture-negative pyogenic vertebral osteomyelitis: a retrospective comparative study with culture-positive pyogenic vertebral osteomyelitis

10.21203/rs.3.rs-42510/v2 ◽

2020 ◽

Author(s):

Dongwoo Yu ◽

Sang Woo Kim ◽

Ikchan Jeon

Keyword(s):

Back Pain ◽

Therapeutic Response ◽

Epidural Abscess ◽

Vertebral Osteomyelitis ◽

Bacterial Identification ◽

Oral Antibiotics ◽

Normal Range ◽

Pyogenic Vertebral Osteomyelitis ◽

Culture Positive ◽

Culture Negative

Abstract Background: There are still controversies regarding the treatment and outcomes in culture-negative pyogenic vertebral osteomyelitis (PVO). The purpose of this study is to investigate the antimicrobial therapy, assessment of therapeutic response, and outcome of culture-negative PVO compared to culture-positive PVO.Methods: A retrospective study was performed with non-surgical lumbar PVO patients. The patients were divided into two groups based on the causative bacterial identification (CN group with culture-negative PVO and CP group with culture-positive PVO). The clinical features, use of antibiotics, laboratory data, and outcomes were compared between the two groups.Results: Seventy-three patients with 41 (56.2%) of the CN group and 32 (43.8%) of the CP group were enrolled. The CN group showed a shorter duration of parenteral antibiotics (45.88 ± 16.14 vs. 57.31 ± 24.39, p = 0.019) but a tendency of prolonged duration of total (parenteral + oral) antibiotics (101.17 ± 52.84 vs. 84.19 ± 50.29 days, p = 0.168). When parenteral antibiotics were discontinued or switched to oral antibiotics, the mean erythrocyte segmentation rate (ESR, normal range: < 25 mm/h), C-reactive protein (CRP, normal range: < 0.5 mg/dL) level, and visual analog scale (VAS) score of back pain were 42.86 ± 24.05 mm/h, 0.91 ± 1.18 mg/dL, and 4.05 ± 1.07, respectively, with no significant differences between the two groups. The recurrence rates of CN and CP groups were 7.3% (3/41) and 6.3% (2/32), respectively (p=1.000). The presence of epidural abscess was the most significant factor for the identification of causative bacteria (p = 0.002), and there was no significant relationship between the use of empirical antibiotics before tissue culture and the causative bacterial identification (p = 0.194).Conclusions: The CN group required a shorter duration of parenteral antibiotics than the CP group. Discontinuation of parenteral antibiotics or changing the administration route can be considered based on the values of ESR, CRP, and VAS score of back pain. The presence of epidural abscess was the most significant factor for the identification of causative bacteria.

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Spinal infections

The Neurosurgeon's Handbook ◽

10.1093/med/9780198570677.003.0264 ◽

2010 ◽

pp. 355-364

Author(s):

George Samandouras

Keyword(s):

Epidural Abscess ◽

Vertebral Osteomyelitis ◽

Spinal Instrumentation ◽

Spinal Infections

Chapter 7.9 covers spinal infections, including vertebral osteomyelitis, discitis,arachnoiditis, epidural abscess, and spinal instrumentation.

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Limited Clinical Utility of Follow-up Blood Cultures in Patients With Streptococcal Bacteremia: An Opportunity for Blood Culture Stewardship

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa541 ◽

2020 ◽

Vol 7 (12) ◽

Author(s):

Emily A Siegrist ◽

Minkey Wungwattana ◽

Leyla Azis ◽

Patricia Stogsdill ◽

Wendy Y Craig ◽

...

Keyword(s):

Blood Culture ◽

Clinical Utility ◽

Epidural Abscess ◽

Vertebral Osteomyelitis ◽

Blood Cultures ◽

Inclusion Criteria ◽

Streptococcal Species ◽

Persistent Bacteremia ◽

Polymicrobial Bacteremia

Abstract Background The value of positive follow-up blood cultures (FUBCs) in streptococcal bacteremia has not been well defined. Therefore, we explored the frequency of and risk factors for positive FUBC in a retrospective cohort of patients with streptococcal bacteremia. Methods Adults ≥18 years of age, admitted with at least 1 positive blood culture for Streptococcus spp between 2013 and 2018 followed by at least 1 FUBC, were potentially eligible. Positive FUBCs were defined as cultures positive for the same streptococcal species drawn >24 hours after the index culture. We excluded patients with polymicrobial bacteremia. We compared the characteristics of patients with and without a positive FUBC. Results In our single-center cohort, we identified 590 patients with streptococcal bacteremia, and 314 patients met inclusion criteria. Ten patients had FUBC with Streptococcus spp (3.2%), 4 (1.3%) had a contaminant identified, and 3 (1.0%) had a new pathogen isolated. Endocarditis (5 of 10 [50.0%] vs 35 of 304 [11.5%]), epidural abscess (2 of 10 [20%] vs 4 of 304 [1.3%]), and discitis or vertebral osteomyelitis (3 of 10 [30.0%] vs 14 of 304 [4.6%]) were associated with positive FUBC. Patients with positive FUBC had a longer median length of stay (12.9 vs 7.1 days, P = .004) and longer duration of antibiotic treatment (14.9 vs 43.2 days, P = .03). Conclusions Follow-up blood cultures among patients with streptococcal BSI are rarely positive. Clinicians could consider limiting follow-up blood cultures in patients at low risk for deep-seated streptococcal infections, persistent bacteremia, or endovascular infection.

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FRI0437 CT GUIDED NEEDLE BIOPSY IN VERTEBRAL OSTEOMYELITIS: RELIABILITY ANALYSIS AND STUDY OF WHICH FACTORS COULD INFLUENCE ON THE RESULT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6383 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 816.2-816

Author(s):

J. J. Fragio-Gil ◽

R. Gonzalez Mazario ◽

E. Grau García ◽

M. De la Rubia Navarro ◽

C. Pávez Perales ◽

...

Keyword(s):

Antibiotic Treatment ◽

Bone Biopsy ◽

Standard Procedure ◽

Vertebral Osteomyelitis ◽

Clinical History ◽

Chronic Kidney Failure ◽

Blood Cultures ◽

Solid Organ ◽

Ct Guided ◽

Spine Pathology

Background:Vertebral Osteomyelitis is an infectious disease of the vertebral body, also termed spondylodiscitis if the intervertebral disc is involved (which its avascular). Since the bacteriological characterization is in many times difficult and blood cultures are often negative, a bone biopsy is in most of the cases encouraged.Objectives:The aim of this study is to analyze which factors could influence on the result of a CT guided biopsy (CTGB) in vertebral spondylodiscitis patients.Methods:A retrospective observational study was performed including patients diagnosed of spondylodiscitis in a single center who underwent a CTGB. Demographic features and comorbidities, acute phase markers, microbiological results, radiological data, antibiotic exposure, medical complications and the clinical outcomes were also collected for analysis. Standard procedure in our center is performed by Musculoskeletal Specialized Radiologist under local anesthesia and CT control. Abscess sample is collected with a 18G needle with coaxial technique, trying to obtain at least 3 samples. For discal space, a thicker needle (13.5G-15G) is used. A logistic regression including cofounding factors was performed using R software.Results:A total of 86 were included with a mean age of 62.75 (14.98) years old and predominationg male sex (68.60%). 15 patients (17.44%) presented any kind of immunosuppression. Clinical data are summarized in Table 1. Blood cultures were positive in 39.71% and sample culture showed a reliability of 49%. Organism which grew were gram + (66.67%), gram – (12.70%), mycobacteria (12.7%) and fungi (7.94%). In only 16 cases (18.6%) there was isolated the same organism in blood and on biopsy culture. From admission to procedure, a mean of 6 days was observed. Antibiotic treatment had a median value of 2 days (0, 6) and its exposure did not modified the culture positivity (IC 95% [0.274-5.211] p=0.816). Detailed analysis was performed looking for the influence of the days of exposure, which also failed (IC 95% [0.939-1.101] p=0.747). The longer duration of the pain was related to a higher probability of obtaining a negative result on the biopsy (IC 95% [1.004-1.035] p=0.026) (graphic 1). Neither fever (p=0.303) or higher CRP (IC 95% [0.992-1.006] p=0.761) value modified the culture result.Table 1.Demographic and clinical characteristics.N=86%Clinical historyHigh blood pressure4248.84Diabetes Mellitus1922.09Liver cirrhosis1618.60Chronic kidney failure1315.12Active Systemic Malignancy*22.33Rheumatoid arthritis*33.49Spondyloarthritis*11.16HIV infection*44.65Solid organ transplant receptor*33.49%Systemic Amyloidosis*11.16Splenectomy*22.33Previous spine pathology5058.14Underlying/associated endocarditis22.33%*Considered as immunosuppressed patientsConclusion:Even in cases under antibiotic treatment, CTGB displays an acceptable reliability. The longer the length of painful period before diagnosis was related to a higher chance of obtaining a negative result on culture. This result could be explained by a greater aggressiveness of pyogenic organisms that perhaps congregate in the lesser time span instead of non-pyogenic agents, that could deliver in more silent infection.References:[1]IDSA Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in AdultsDisclosure of Interests:None declared

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Antimicrobial therapy and assessing therapeutic response in culture-negative pyogenic vertebral osteomyelitis: a retrospective comparative study with culture-positive pyogenic vertebral osteomyelitis

10.21203/rs.3.rs-42510/v3 ◽

2020 ◽

Author(s):

Dongwoo Yu ◽

Sang Woo Kim ◽

Ikchan Jeon

Keyword(s):

Back Pain ◽

Therapeutic Response ◽

Epidural Abscess ◽

Vertebral Osteomyelitis ◽

Bacterial Identification ◽

Oral Antibiotics ◽

Normal Range ◽

Pyogenic Vertebral Osteomyelitis ◽

Culture Positive ◽

Culture Negative

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Prognosis of spinal infections managed by minimal debridement: A case series in two tertiary centers

Surgical Neurology International ◽

10.25259/sni_29_2021 ◽

2021 ◽

Vol 12 ◽

pp. 83

Author(s):

Ahmed Ali Mohamed ◽

Hussein Mohammed Soffar ◽

Hazem Hassan El Zayat ◽

Hashem Mohamed Aboul-Ela

Keyword(s):

Epidural Abscess ◽

Vertebral Osteomyelitis ◽

Case Series ◽

Clinical Findings ◽

Low Back ◽

Thoracic Region ◽

Limb Pain ◽

Lower Limb Pain ◽

Spinal Infections

Background: Spinal infections can be challenging in their management and include spondylitis, epidural abscess, and spondylodiscitis. Usual treatment is conservative through antimicrobials or surgery to decompress neural tissue, debride all infected tissues, and fix if needed. We propose the concept of surgery without formal debridement aiming at neural protection. Methods: The study was performed at two tertiary centers on 25 patients with clinical findings. One patient was treated conservatively and the rest surgically by laminectomy and fixation if needed. Evacuation of fluid pus was performed. In the cervical and the thoracic region, if the granulation tissue was anterior to the cord, only decompression by laminectomy was done. Results: Low back pain was present in 22 cases (88%), 16 cases (64%) had lower limb pain, and 12 cases (48%) had weakness. The level of spinal infection was lumbar in 15 cases (60%), thoracic in 9 cases (36%) cases, and cervical in 1 case (4%). The type of infection was epidural abscess in 20 cases (80%), discitis in 16 cases (64%), and vertebral osteomyelitis in 12 cases (48%). Laminectomy was performed in 20 cases (80%) and fixation in 17 cases (68%). The symptoms improved in all cases. On follow-up, the lesion was reduced in 14 patients (56%) and disappeared in 11 cases (44%). One case required ventriculoperitoneal shunt placement due to postinfectious hydrocephalus. Conclusion: Dealing with spinal infections surgically through decompression or fixation with minimal debridement of infected tissue appears to be a safe and effective method of management.

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The Diagnosis and Management of Patients with Spinal Infections (Including Vertebral Osteomyelitis, Spondylodiscitis and Epidural Abscess)

MOJ Orthopedics & Rheumatology ◽

10.15406/mojor.2016.04.00136 ◽

2016 ◽

Vol 4 (3) ◽

Author(s):

Bob Chatterjee

Keyword(s):

Epidural Abscess ◽

Vertebral Osteomyelitis ◽

Diagnosis And Management ◽

Spinal Infections

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Prognostic Value Of Blood Cultures as an Illness Severity Marker In Emergency Medical Admissions

Acute Medicine Journal ◽

10.52964/amja.0806 ◽

2020 ◽

Vol 19 (2) ◽

pp. 83-89

Author(s):

Richard Conway ◽

◽

Brian O’Connell ◽

Declan Byrne ◽

Deirdre O’Riordan ◽

...

Keyword(s):

Blood Culture ◽

Prognostic Value ◽

Positive Culture ◽

Illness Severity ◽

Blood Cultures ◽

Multivariable Logistic Regression Model ◽

Negative Culture ◽

Culture Performance ◽

Culture Positive ◽

Culture Negative

Background: Positive blood cultures predict mortality. The prognostic value of blood culture performance itself has not been fully defined. Methods: We evaluated medical admissions from 2002-2017. We defined blood culture category as 1) no culture 2) negative culture 3) positive culture. We employed a multivariable logistic regression model to evaluate outcomes. Results: We evaluated 78,568 blood cultures in 106,586 admissions. 30-day in-hospital mortality for no culture was 2.8% (95%CI 2.7, 2.9), culture negative 8.9% (95%CI 8.5, 9.3) and culture positive 16.7% (95%CI 15.5, 17.9). There was significant interaction between blood culture category and illness severity, OR 1.06 (95%CI 1.05, 1.08), and comorbidity, OR 1.09 (95%CI 1.09, 1.10). Conclusion: Performance and results of blood cultures are independently associated with increased mortality.

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