334. Treatment Duration of Antibiotics for Sacral Osteomyelitis After Skin Flap Procedure

Abstract Background Patients with spinal cord injuries frequently develop sacral osteomyelitis. Optimal treatment often involves intravenous antibiotics and skin flap closure of the ulcer; however, best practices for the duration of antibiotic therapy pre- and post-procedure are unknown. Methods This was a retrospective, cohort study of spinal cord injury patients at the VA St. Louis undergoing a skin flap procedure from 1 October 2014 to 31 March 2019. Patients aged 18 to 89 years with a documented spinal cord injury and receiving treatment for sacral osteomyelitis with antibiotics and skin flap placement were considered for inclusion. The primary outcome was to determine if there was a difference in antibiotic treatment duration, both pre-procedure and post-procedure, between those that failed combination therapy and those patients for which the treatment was successful. Treatment failure was defined as documentation of no resolution of sacral osteomyelitis after treatment, re-initiation of antibiotics for sacral osteomyelitis of the same area, documented flap break-down, or an unplanned flap-related procedure within 1 year of completion of antibiotic therapy. Results Twelve patients were identified for inclusion. Baseline characteristics were similar between groups; 5/8 patients successfully treated received vancomycin, compared to 4/4 patients that failed therapy. Overall, 75% (8/12) had a successful treatment outcome at 12 months. In qualifying patients, average days of pre-procedure and post-procedure antibiotics were similar between patients who achieved success and those who failed (45.5 vs. 44.3 days pre-procedure, respectively (p >0.05) and 39 vs. 43 days post-procedure (p >0.05), respectively). When evaluated by weeks of therapy, no statistically significant differences were noted in treatment success rates between those treated for less than 6 weeks versus those treated for longer (66.6% [2/3] vs. 63.6% [6/9], p >0.05). Conclusion No difference in pre- or post-flap procedure antibiotic duration was observed in patients who failed therapy compared to those who were successfully treated. Disclosures All Authors: No reported disclosures

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EFFECTS OF ANTIBIOTIC THERAPY ON THE APPEARANCE OF THE ABNORMAL MICTURITION REFLEX AFTER SPINAL CORD INJURY IN RATS

The Journal of Urology ◽

10.1016/s0022-5347(08)61020-4 ◽

2008 ◽

Vol 179 (4S) ◽

pp. 348-349

Author(s):

Dong Broqueres-You ◽

Delphine Behr-Roussel ◽

Stephanie Oger ◽

Pierre Denys ◽

Laurent Alexandre ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Antibiotic Therapy ◽

Micturition Reflex ◽

Cord Injury

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Risk factors of pelvic pressure ulcer recurrence after primary skin flap surgery in people with spinal cord injury

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2018.08.005 ◽

2019 ◽

Vol 62 (2) ◽

pp. 77-83

Author(s):

J. Morel ◽

C. Herlin ◽

B. Amara ◽

C. Mauri ◽

H. Rouays ◽

...

Keyword(s):

Risk Factors ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Pressure Ulcer ◽

Skin Flap ◽

Ulcer Recurrence ◽

Flap Surgery ◽

Cord Injury ◽

Pelvic Pressure

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Biomarker-based Assessment of Urinary Tract Infection in Persons with Spinal Cord Injury

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.848 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S352-S352

Author(s):

M David Mansouri ◽

Perumal Thiagarajan ◽

Dena Mansouri ◽

S Ann Holmes

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Antibiotic Therapy ◽

Asymptomatic Bacteriuria ◽

Early Assessment ◽

Clinical Criteria ◽

Cord Injury

Abstract Background Urinary tract infection (UTI) is the most common infection and the second leading cause of death in spinal cord injury (SCI) patients. However, there is currently no consensus about the clinical criteria for UTI in SCI patients and the lack of a universal definition of asymptomatic bacteriuria (ABU) make the diagnosis even more complex and the treatment recommendations problematic. Prompt diagnosis and timely treatment of UTI are important to prevent possible progression to sepsis. Elevated concentrations of some biomarkers may be correlated with infection and their serial measurements may be helpful to assess the effectiveness of antibiotic therapy. Methods Fifteen SCI participants were enrolled for either lower UTI, upper UTI (pyelonephritis), ABU, or control. Patients suspected of having any inflammation or infection other than UTI were excluded. Participants were monitored for their serum procalcitonin (PCT) and c-reactive protein (CRP) levels initially and every 3 days once the UTI was confirmed and antibiotics prescribed. In addition, the urine was cultured initially and every three days in patients with UTI for correlation with biomarkers. UTI/ABU was assessed by patient’s physician. Results Both mean initial PCT and CRP were significantly higher in patients with lower UTI (P = 0.027 and P = 0.001, respectively) and those with upper UTI (P = 0.044 and P < 0.0001, respectively) compared with control and ABU participants. PCT and CRP were generally reduced to the normal levels gradually during the course of antibiotic therapy for those patients with UTI that were placed on antibiotic therapy. Mean bacterial colonies grown from initial urine cultures in patients with upper or lower UTI were >100,000 CFU/mL. Control participants had urine cultures of ≤1,000 CFU/mL). Generally, cultures from UTI patients placed on antibiotics were negative for the organism(s) treated for during or after the completion of antibiotic therapy. Conclusion Serum concentrations of CRP and PCT may be used to aid in the early assessment of UTI in SCI patients in the absence of other sources of inflammation and/or infection. In general, CRP measurements are more pronounced than PCT measurements in patients with ABU or lower UTI. However, PCT levels elevate conspicuously in patient with pyelonephritis. Disclosures All authors: No reported disclosures.

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