scholarly journals 1426. Outcomes of Additional Instrumentation in Elderly Patients with Pyogenic Vertebral Osteomyelitis and Previous Spinal Instrumentation

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S519-S520
Author(s):  
Tae-Hwan Kim ◽  
Jihye Kim
Keyword(s):  
Clinical Outcomes ◽  
Psoas Abscess ◽  
Vertebral Osteomyelitis ◽  
Spinal Instrumentation ◽  
Multivariate Logistic Regression Analysis ◽  
Complete Removal ◽  
Pyogenic Vertebral Osteomyelitis ◽  
Baseline Characteristics ◽  
Control Study ◽  
Infection Recurrence

Abstract Background In patients with pyogenic vertebral osteomyelitis (PVO) and previous instrumentation requiring surgical treatment, a decision must be made between a less invasive non-instrumented surgery, including retaining the previous instrumentation, or a more invasive additional instrumented surgery involving the complete removal of the infected tissue and firm re-stabilization. Methods A retrospective cohort study (case–control study) was planned to evaluate the clinical outcomes of using additional instrumentation in patients with PVO and previous instrumentation. Patients were divided into two groups (instrumented or non-instrumented) according to the presence or absence of additional instrumentation. The baseline characteristics, infection profile, and treatment outcomes were compared between the two groups, and a multivariate logistic regression analysis was performed to identify the risk factors for infection recurrence. Results A total of 187 postoperative patients with PVO and previous spinal instrumentation were included. There were no significant differences in the baseline characteristics except the presence of a titanium cage. Surgery for additional instrumentation in patients with PVO and previous instrumentation showed similar rates of infection recurrence and mortality compared with non-instrumented surgery despite a larger number of involved vertebral levels and greater incidence of epidural abscesses (Table 1). However, instrumented patients with PVO and previous instrumentation who experienced infection recurrence had worse clinical outcomes than those of the non-instrumented patients with PVO (Table 2). Severe medical comorbidities, the presence of a psoas abscess (Figures 1 and 2), and methicillin-resistant Staphylococcus aureus infection were associated with a higher risk of infection recurrence. Conclusion Surgery for additional instrumentation in patients with PVO and previous instrumentation showed similar rates of infection recurrence and mortality to those who underwent non-instrumented surgery despite a larger number of involved vertebral levels and an increased frequency of epidural abscesses. Disclosures All authors: No reported disclosures.

scholarly journals Epidemiology, Microbiological Diagnosis, and Clinical Outcomes in Pyogenic Vertebral Osteomyelitis: A 10-year Retrospective Cohort Study

2018 ◽  
Vol 5 (3) ◽  
Author(s):  
Brian S W Chong ◽  
Christopher J Brereton ◽  
Alexander Gordon ◽  
Joshua S Davis
Keyword(s):  
Cohort Study ◽  
Clinical Outcomes ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Vertebral Osteomyelitis ◽  
Index Admission ◽  
Causative Organism ◽  
Microbiological Diagnosis ◽  
Treatment Pathways ◽  
Pyogenic Vertebral Osteomyelitis

Abstract Background Pyogenic vertebral osteomyelitis (PVO) is rising in incidence, but optimal methods of investigation and duration of antibiotic therapy remain controversial. Methods We conducted a single-center retrospective cohort study of PVO at an Australian teaching hospital. We included all adults with a first episode of PVO between 2006 and 2015. PVO was defined based on the presence of prespecified clinical and radiological criteria. The main exposures of interest were investigation strategy and antibiotic treatment. The main outcome measures were duration of hospital admission, mortality during index admission, symptom resolution during index admission, and attributable readmission within 2 years. Results Of 129 included patients, 101 (78%) had a causative organism identified. Patients with an identified pathogen were more likely to be febrile (75% compared with 29%, P < .001) and had a higher mean admission C-reactive protein (207 vs 54, P < .001) compared with patients without an identified pathogen. However, they were less likely to experience an adverse outcome (death or attributable readmission within 2 years; adjusted odds ratio, 0.36; 95% confidence interval, 0.13–0.99; P = .04). Open biopsy of vertebral tissue had a higher diagnostic yield (70%) than fine needle aspirate (41%) or core biopsy (30%). Despite receiving a median of 6 weeks of intravenous antibiotics, only 15% of patients had a full recovery on discharge from index admission. Conclusions Clinical outcomes for patients with PVO were poor. Obtaining a microbiological diagnosis is associated with a better outcome. However, prospective and randomized studies are essential to establishing optimal investigation and treatment pathways.

scholarly journals 2269. Clinical Outcomes in Patients with Carbapenem-Non-Susceptible, β-Lactam-Susceptible Pseudomonas aeruginosa Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S776-S777
Author(s):  
Victoria M Gavaghan ◽  
Michelle Lee ◽  
David Butler ◽  
Mark Biagi ◽  
Maressa Santarossa ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Clinical Outcomes ◽  
Primary Outcome ◽  
Empiric Therapy ◽  
Descriptive Statistics ◽  
Treatment Information ◽  
Multicenter Cohort ◽  
Baseline Characteristics ◽  
Unique Genotype ◽  
Infection Recurrence

Abstract Background Pseudomonas aeruginosa (PsAr) isolates harboring OprD mutations often present phenotypically as carbapenem nonsusceptible but susceptible to antipseudomonal β-lactams (APBLs). It is unknown whether this unique genotype–phenotype combination affects the clinical outcomes of patients infected with these pathogens. The objective of this study was to compare clinical outcomes of patients treated with APBLs for pneumonia and/or bacteremia caused by PsAr bearing this unique carbapenem nonsusceptible, β-lactam susceptible phenotype (Carba-NS) to those retaining susceptibility to both carbapenems and APBLs (Carba-S). Methods Retrospective multicenter cohort of adult in-patients who received effective APBL for PsAr pneumonia and/or bacteremia from January 2012 to November 2018. Baseline characteristics, treatment information, and clinical outcomes were obtained from the electronic medical record. The primary outcome was 14-day mortality. Secondary outcomes included 30-day mortality, 30-day infection recurrence, and infection-related length of stay (IR-LOS). IR-LOS was defined as the time from index culture to antibiotic discontinuation or hospital discharge, whichever was sooner. Descriptive statistics were analyzed using SPSS. Results 387 patients were evaluated; 60 Carba-S and 21 Carba-NS were included. The primary reason for exclusion was ineffective empiric therapy. Select demographics and clinical outcomes are displayed in Table 1. Compared with the Carba-S group, Carba-NS patients were younger, had better renal function, increased incidence of pneumonia, more severely ill, and higher rate of empiric ceftazidime use. Despite these differences at baseline there were no significant differences in empiric APBL treatment patterns, 14- or 30-day mortality, or recurrence at 30 days between the groups. Carba-NS patients had lower rate of oral step down therapy and a significantly longer LOS and IR-LOS. Conclusion In this cohort of patients who received appropriate and timely APBL therapy, the Carba-NS phenotype was not associated with increased rates of 14-day mortality, 30-day mortality, or 30-day infection recurrence. These data suggest that APBLs may be effective therapeutic options against this phenotype. Further research is warranted to confirm these findings. Disclosures All authors: No reported disclosures.

scholarly journals Clinical Outcomes in Older Patients Aged over 75 Years Who Underwent Early Surgical Treatment for Pyogenic Vertebral Osteomyelitis

2021 ◽  
Vol 10 (22) ◽  
pp. 5451
Author(s):  
Jeong Hwan Lee ◽  
Jihye Kim ◽  
Tae-Hwan Kim
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Older Patients ◽  
Multivariable Analysis ◽  
Vertebral Osteomyelitis ◽  
Spinal Instrumentation ◽  
Nonoperative Treatment ◽  
Adverse Outcomes ◽  
Neurologic Deficits ◽  
Pyogenic Vertebral Osteomyelitis

Older patients with pyogenic vertebral osteomyelitis (PVO) usually have more medical comorbidities compared with younger patients, and present with advanced infections from different causative organisms. To aid surgical decision-making, we compared surgical outcomes of older patients with PVO to those who underwent nonoperative treatment. We identified the risk factors for adverse post-operative outcomes, and analyzed the clinical risks from further spinal instrumentation. This retrospective comparative study included 439 patients aged ≥75 years with PVO. Multivariable analysis was performed to compare treatment outcomes among three groups: 194, 130, and 115 patients in the non-operative, non-instrumented, and instrumented groups, respectively. The risk factors for adverse outcomes after surgical treatment were evaluated using a logistic regression model, and the estimates of the multivariable models were internally validated using bootstrap samples. Recurrence and mortality of these patients were closely associated with neurologic deficits, and increased surgical invasiveness, resulting from additional spinal instrumentation, did not increase the risk of recurrence or mortality. We propose that surgical treatment for these patients should focus on improving neurologic deficits through immediate and sufficient removal of abscesses. Spinal instrumentation can be performed if indicated, within reasonable clinical risk.

scholarly journals Reply to “Therapeutic Outcomes of Pyogenic Vertebral Osteomyelitis Requiring Spinal Instrumentation”

2014 ◽  
Vol 58 (11) ◽  
pp. 7022-7022
Author(s):  
Ryan Arnold ◽  
Clare Rock ◽  
Lindsay Croft ◽  
Bruce L. Gilliam ◽  
Daniel J. Morgan
Keyword(s):  
Vertebral Osteomyelitis ◽  
Spinal Instrumentation ◽  
Therapeutic Outcomes ◽  
Pyogenic Vertebral Osteomyelitis

Outcomes of additional instrumentation in elderly patients with pyogenic vertebral osteomyelitis and previous spinal instrumentation

2019 ◽  
Vol 19 (9) ◽  
pp. 1498-1511 ◽  
Author(s):  
Jihye Kim ◽  
Jeong Hwan Lee ◽  
Seok Woo Kim ◽  
Jae-Keun Oh ◽  
Young-Woo Kim ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Vertebral Osteomyelitis ◽  
Spinal Instrumentation ◽  
Pyogenic Vertebral Osteomyelitis

scholarly journals Treating Critically Ill Patients Experiencing SARS-CoV-2 Severe Infection with Ig-M and Ig-A Enriched Ig-G Infusion

Antibiotics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 930
Author(s):  
Alberto Corona ◽  
Giuseppe Richini ◽  
Sara Simoncini ◽  
Marta Zangrandi ◽  
Monica Biasini ◽  
...  
Keyword(s):  
Immunoglobulin G ◽  
Standard Therapy ◽  
Severe Infection ◽  
Treated Group ◽  
Simplified Acute Physiology Score ◽  
Retrospective Case ◽  
Baseline Characteristics ◽  
Time Of Admission ◽  
Ig G ◽  
Control Study

SARS-CoV-2 in patients who need intensive care unit (ICU) is associated with a mortality rate ranging from 10 to 40–45%, with an increase in morbidity and mortality in presence of sepsis. We hypothesized that IgM and IgA enriched immunoglobulin G may support the sepsis-related phase improving patient outcome. We conducted a retrospective case–control study on 47 consecutive patients admitted to our ICU. At the time of admission, patients received anticoagulants (heparin sodium) together with the standard supportive treatment. We decided to add IgM and IgA enriched immunoglobulin G to the standard therapy. Patients receiving IgM and IgA enriched immunoglobulin G were compared with patients with similar baseline characteristics and treatment, receiving only standard therapy. The mortality resulted significantly higher in patients treated with standard therapy only (56.5 vs. 37.5%, p < 0.01) and, at day 7, the probability of dying was 3 times higher in this group. Variable life adjustment display (VLAD) was 2.4 and -2.2 (in terms of lives saved in relation with those expected and derived from Simplified Acute Physiology Score II) in the treated and not treated group, respectively. The treatment based on IgM and IgA enriched immunoglobulin G infusion seems to give an advantage on survival in SARS-CoV-2 severe infection.

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