scholarly journals 237. Evaluating Epidural Abscess Outcomes in a County Hospital with Antibiotic Therapy Alone Compared to Antibiotics and Surgical Intervention

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S228-S228
Author(s):  
Moses Lee ◽  
Yazeed Kesbeh ◽  
Bruce Weng ◽  
Made Sutjita
Keyword(s):  
Staphylococcus Aureus ◽  
Alcohol Abuse ◽  
Epidural Abscess ◽  
Surgical Intervention ◽  
Case Series ◽  
County Hospital ◽  
Joint Disease ◽  
Spinal Epidural Abscess ◽  
Sample Collection ◽  
Retrospective Case

Abstract Background Spinal epidural abscess (SEA) remains a rare suppurative infection which bacteria invade the epidural space through contiguous spread or hematogenous dissemination. Diabetes mellitus (DM), IV drug abuse (IVDA), alcohol abuse, degenerative joint disease (DJD) have been shown to confer risk for SEA. Antimicrobial therapy is critical, but literature remains less clear on surgical intervention. Primary aim for study was to evaluated outcomes with SEA when treated with antibiotics alone compared to antibiotics and surgical intervention at our county hospital. Methods A retrospective case series assessed patients 18 years or older at our county hospital with SEA consulted by infectious disease from 7/2009 to 7/2018. Data collected included demographics, social history (IVDA, alcohol abuse, homelessness), and microbiology results. Physician review of records determined if outcomes of SEA demonstrated improvement of symptoms compared to no improvement of symptoms. Results Of 37 patients, 15 patients were treated with antibiotics alone, 22 with antibiotics plus surgical spinal intervention. Of patients treated with antibiotics alone, 12/15 (80%) had improvement of symptoms and 3/15 (20%) had no improvement of symptoms. Those treated with antibiotics plus surgical intervention, 17/22 (77%) had improvement or resolution of symptoms and 5/22 (23%) had no improvement of symptoms. No statistically difference in outcome was observed between the two groups (p=0.835). The majority of cases were positive for Staphylococcus aureus (21/37, 56.7%). Methicillin-sensitive S. aureus (MSSA) comprised (12/21, 57%) and Methicillin-resistant S. aureus (MRSA) comprised (9/21, 43%). Conclusion Our retrospective study demonstrated no differences in outcome observed between patients treated with antibiotics alone compared to those with antibiotics plus surgical spinal intervention. Staphylococcus aureus was the most common organism. Management of patients with SEA currently remains individualized based on clinical condition, comorbidities and clinician judgement given limited literature. Proper sample collection for cultures and immediate intervention, either antibiotics only or antibiotics plus surgical interventions are crucial for better patient outcomes in SEA. Disclosures All Authors: No reported disclosures

scholarly journals Community-Acquired MRSA Pyomyositis: Case Report and Review of the Literature

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Douglas P. Olson ◽  
Sarita Soares ◽  
Sandhya V. Kanade
Keyword(s):  
Epidural Abscess ◽  
Surgical Intervention ◽  
Cauda Equina ◽  
Spinal Epidural Abscess ◽  
Paraspinal Muscles ◽  
Sensory Deficits ◽  
Antibiotic Management ◽  
History Of ◽  
Spinal Epidural ◽  
Repeat Imaging

Community-acquired methicillin-resistantStaphylococcus aureus(CA-MRSA) is responsible for a broad range of infections. We report the case of a 46-year-old gentleman with a history of untreated, uncomplicated Hepatitis C who presented with a 2-month history of back pain and was found to have abscesses in his psoas and right paraspinal muscles with subsequent lumbar spine osteomyelitis. Despite drainage and appropriate antibiotic management the patient's clinical condition deteriorated and he developed new upper extremity weakness and sensory deficits on physical exam. Repeat imaging showed new, severe compression of the spinal cord and cauda equina from C1 to the sacrum by a spinal epidural abscess. After surgical intervention and continued medical therapy, the patient recovered completely. This case illustrates a case of CA-MRSA pyomyositis that progressed to lumbar osteomyelitis and a spinal epidural abscess extending the entire length of the spinal canal.

scholarly journals Intersection syndrome: an acute surgical disease in elite rowers

2019 ◽  
Vol 5 (1) ◽  
pp. e000535 ◽  
Author(s):  
Gregory Hoy ◽  
Larissa Trease ◽  
Wendy Braybon (Deceased)
Keyword(s):  
Surgical Intervention ◽  
Case Series ◽  
Operative Management ◽  
Retrospective Case ◽  
Training Time ◽  
Best Management ◽  
Elite Rowers ◽  
The 1960S ◽  
Early Surgical Intervention ◽  
Intersection Syndrome

ObjectiveIntersection syndrome is a relatively common condition in elite rowers and continuing conjecture over its pathology and best management often includes prolonged withdrawal from training and changes to the technique that may affect rowing outcomes.MethodsWe reviewed a case series in a national rowing squad and the effect on time loss produced by the condition. We reviewed the pathophysiology. We revisited the aggressive operative management put forward in the 1960s and applied it to modern rowing workload by reviewing a retrospective case series of six international rowers who had early surgical intervention.ResultsApproximately 5% of the squad suffered intersection syndrome during a 3-year period. The effect on training time was between 20% and 40% of their training time in the period. Using our understanding of the pathology as a true tendinitis of the second wrist compartment caused by fascial compression from hypertrophied first compartment muscles, we advocated earlier surgery and almost immediate return to training, which occurred at a median of 7 days postsurgery. We had successful return in five of six rowers in an accelerated programme to minimise muscle wasting and technique modification caused by the condition, achieving career goals in a matter of weeks after surgical intervention.ConclusionsWe encourage early surgical management of intersection syndrome of the wrist to allow almost immediate return to training, and therefore interfere less with technique modification and time out of the water. This minimises career disruption in the elite rowing community.

Aggressive Surgical Intervention in End-Stage Renal Disease Patients with Spinal Epidural Abscess

Renal Failure ◽  
2011 ◽  
Vol 33 (6) ◽  
pp. 582-586 ◽  
Author(s):  
Mei-Yi Wu ◽  
Tsai-Sheng Fu ◽  
Chih-Hsiang Chang ◽  
Hsiang-Hao Hsu ◽  
Ming-Yang Chang ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Epidural Abscess ◽  
Surgical Intervention ◽  
Spinal Epidural Abscess ◽  
Stage Renal Disease ◽  
End Stage ◽  
Spinal Epidural

A Retrospective Case Series of Telavancin for the Treatment of Staphylococcus aureus Bacteremia

2018 ◽  
Vol 26 (5) ◽  
pp. 264-269
Author(s):  
Louis D. Saravolatz ◽  
Kerry O. Cleveland ◽  
Khalid Rikabi ◽  
Ali Hassoun ◽  
Joseph Reilly ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Case Series ◽  
Retrospective Case ◽  
Staphylococcus Aureus Bacteremia ◽  
Retrospective Case Series

Midfoot Arthrodesis following Multi-Joint Stabilization with a Novel Hybrid Plating System

2012 ◽  
Vol 33 (3) ◽  
pp. 220-225 ◽  
Author(s):  
Jorge Filippi ◽  
Mark S. Myerson ◽  
Mark W. Scioli ◽  
Bryan Dale Den Hartog ◽  
David B. Kay ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Body Mass Index ◽  
Healing Rate ◽  
Case Series ◽  
The Other ◽  
Joint Disease ◽  
Retrospective Case ◽  
Exclusion Criteria ◽  
Level Of Evidence ◽  
Joint Gap

Background: Several methods for fixation have been described for midfoot arthrodesis. Multi-joint arthrodesis at this level can be challenging because of bone loss and deformity, making it difficult to obtain a stable construct. We present the results of a novel hybrid plating system that incorporates locked and non-locked compression screws for multi-joint arthrodesis of the midfoot. Method: A retrospective multicenter review of patients undergoing multi-joint arthrodesis with hybrid plating of the midfoot was performed to evaluate the time to radiographic arthrodesis. Hybrid plating was defined as a construct that incorporates locked and non-locked compression screws. Neuropathy was the only exclusion criteria. Radiographic arthrodesis was defined as bridging bone on one of the three standard foot radiographs in the absence of a joint gap on the other views, or by 50% or greater bridging bone on computed tomography. Etiology of the arthritis, presurgical comorbidities, body mass index, functional level and postoperative complications were evaluated. Results: Seventy-two patients were evaluated, and arthrodesis was obtained in 67 patients at 6 weeks in 27 patients, 9 weeks in 26, 12 weeks in 11, and at 16 weeks in three. In five patients at least one of the joints were not fused at 16 weeks and were considered a nonunion. Complications were present in 12 patients (17%). Conclusions: The healing rate and time to arthrodesis compared favorably to similar published studies. Based on these results, hybrid plating was a reliable and consistent alternative for fixation in midfoot arthrodesis, especially in multi-joint disease. Level of Evidence: IV; Retrospective Case Series

scholarly journals Spinal Epidural Abscess İn An Adolescent (Case Report)

2021 ◽  
Author(s):  
Meryem Badem ◽  
Serpil Ugur Baysal ◽  
İlknur Karyağdı ◽  
Nusret Oren ◽  
Hamit Selim Karabekir ◽  
...  
Keyword(s):  
Medical Literature ◽  
Epidural Abscess ◽  
Surgical Intervention ◽  
Neurological Deficits ◽  
Spinal Epidural Abscess ◽  
Spinal Magnetic Resonance Imaging ◽  
Serious Infection ◽  
English Medical Literature ◽  
Spinal Epidural ◽  
Systemic Antibiotics

Spinal infections in immunocompetent children are very rare. But it is a serious infection in the epidural space along the spinal cord. It should be considered in patients with backache, fever, neurological deficits and/or spinal tenderness. There are cases which an etiology could not determined. In the English medical literature, there are only 31 reported pediatric cases in the last two decades. In children with neurologic deficits, surgery combined with systemic antibiotics constitutes the optimal therapy. We report a case of thoracal spinal epidural abscess in a 12-year-old adolescent boy who was immunocompetent and presented with spinal tenderness, back pain and four days of fever. A spinal magnetic resonance imaging demonstrated an epidural abscess between T2 and T10 level. An emergent surgical intervention was applied. Cultures remained negative. He was given systemic antibiotics for six weeks. He recovered without any sequelae.

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