Antibiotic-Resistant Spondylodiscitis With Canal Invasion and Aggressive Evolution to Epidural Abscess: A Case Series of Spontaneous Occurrence in 16 Patients

Fecal microbiota transplantation (FMT), which has been established as the standard treatment for recurrent <i>Clostroides</i> difficile infection, may also play a role in the management of other diseases associated with dysbiosis of the gut microbiota. To ensure efficacy and safety of FMT, an appropriate donor screening process is required. The main purpose of donor screening is to check for infectious diseases that could be transmitted to the recipient. The screening process involves a medical history questionnaire, and blood and stool testing. Several randomized clinical trials and large case series on FMT reported no, or few, adverse events related to infection by following this donor screening process. However, there is still concern over the transmission of antibiotic-resistant bacteria. In addition, a low donor acceptance rate due to rigorous screening makes donor recruitment difficult, and also imposes a significant cost burden. A consensus on the most crucial elements of donor screening is needed for wide application of FMT.

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Medical-Grade Honey Kills Antibiotic-Resistant Bacteria and Prevents Amputation in Diabetics with Infected Ulcers: A Prospective Case Series

Antibiotics ◽

10.3390/antibiotics9090529 ◽

2020 ◽

Vol 9 (9) ◽

pp. 529

Author(s):

Harikrishna K. R. Nair ◽

Nektarios Tatavilis ◽

Ivana Pospíšilová ◽

Jana Kučerová ◽

Niels A. J. Cremers

Keyword(s):

At Risk ◽

Wound Healing ◽

Case Series ◽

Complementary Therapy ◽

Resistant Bacteria ◽

Antibiotic Resistant ◽

Promising Alternative ◽

Diabetic Ulcers ◽

Surgical Closure ◽

Medical Grade

Diabetic ulcers are at risk of becoming chronic and infected, as diabetics have hampered vascular structures, limiting oxygen and nutrient supply. These wounds can lead to pain, malodor, functional problems, and amputation. The current rise in antibiotic resistance demands for complementary therapies. Medical-grade honey (MGH) forms an attractive option because of its antimicrobial and pro-healing properties. We aim to show the beneficial effects of MGH in infected diabetic ulcers. We present six patients with infected diabetic ulcers, of which some were at risk of (further) amputation. Previous treatments with antibiotics, silver and alginate dressings, surgical closure, and maggot therapy were ineffective; therefore, the treatment was switched to the application of MGH. MGH therapy typically reduced the malodor in a couple of days and controlled infection within 2–3 weeks. MGH also enhanced wound healing by promoting granulation tissue formation, angiogenesis, and re-epithelialization, by decreasing inflammatory and oxidative stress and providing nutrients. Together, wound healing was enhanced, and the patient’s quality of life improved. MGH is safe and cost-effective for treating complicated diabetic wounds with (antibiotic-resistant) infections and at risk of amputation. MGH forms a promising alternative or complementary therapy to replace antibiotics for treating locally infected wounds.

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Management of cervical spine epidural abscess: a systematic review

Therapeutic Advances in Infectious Disease ◽

10.1177/2049936119863940 ◽

2019 ◽

Vol 6 ◽

pp. 204993611986394

Author(s):

Anastasia Turner ◽

Linlu Zhao ◽

Paul Gauthier ◽

Suzan Chen ◽

Darren M. Roffey ◽

...

Keyword(s):

Patient Outcomes ◽

Medical Management ◽

Epidural Abscess ◽

Treatment Options ◽

Spinal Column ◽

Case Series ◽

Spinal Epidural Abscess ◽

Optimal Method ◽

Initial Surgery ◽

Spinal Epidural

Background: Cervical spinal epidural abscess (CSEA) is a localized infection between the thecal sac and cervical spinal column which may result in neurological deficit and death if inadequately treated. Two treatment options exist: medical management and surgical intervention. Our objective was to analyze CSEA patient outcomes in order to determine the optimal method of treatment. Methods: An electronic literature search for relevant case series and retrospective reviews was conducted through June 2016. Data abstraction and study quality assessment were performed by two independent reviewers. A lack of available data led to a post hoc decision not to perform meta-analysis of the results; study findings were synthesized qualitatively. Results: 927 studies were identified, of which 11 were included. Four studies were ranked as good quality, and seven ranked as fair quality. In total, data from 173 patients were included. Mean age was 55 years; 61.3% were male. Intravenous drug use was the most common risk factor for CSEA development. Staphylococcus aureus was the most commonly cultured pathogen. 140 patients underwent initial surgery, an additional 18 patients were surgically treated upon failure of medical management, and 15 patients were treated with antibiotics alone. Conclusion: The rates of medical management failure described in our review were much higher than those reported in the literature for thoracolumbar spinal epidural abscess patients, suggesting that CSEA patients may be at a greater risk for poor outcomes following nonoperative treatment. Thus, early surgery appears most viable for optimizing CSEA patient outcomes. Further research is needed in order to corroborate these recommendations.

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Subutex® Abuse Presenting to the Emergency Department: A Case Series

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490790701400306 ◽

2007 ◽

Vol 14 (3) ◽

pp. 163-168

Author(s):

HC Chew

Keyword(s):

Emergency Department ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Epidural Abscess ◽

Public Awareness ◽

Case Series ◽

Opiate Withdrawal ◽

Limb Ischaemia ◽

Sublingual Buprenorphine ◽

High Index Of Suspicion

Introduction Subutex® (sublingual buprenorphine hydrochloride) tablets are prescribed to alleviate symptoms of opiate withdrawal in addicts undergoing a cessation programme. Although Subutex® is safe and effective, parenteral abuse is an emerging phenomenon. A variety of complications may present due to the different areas that patients inject themselves. Aim We present a case series of four patients who presented to the emergency department following complications of Subutex® abuse. The complications included deep venous thrombosis, limb ischaemia and epidural abscess with osteomyelitis of the spine. Discussion Sublingual buprenorphine was launched in Singapore in 2002. It is currently the preferred alternative to methadone for treating opiate dependency locally. Despite safeguards, instances of abuse of buprenorphine exist. These medications can be passed or sold to others not on a cessation programme. Two of the 4 patients in this series obtained Subutex® illegally. Parenteral abuse of Subutex® is of grave concern. In Australia and France, between 23–37% of Subutex® users have abused it in this fashion. Conclusion Subutex® abuse is not uncommon in Singapore. Complications especially from parenteral use can occur and may result in serious morbidity. A high index of suspicion among physicians must be maintained in patients with unusual limb infections, ischaemia or venous thrombosis. Tighter regulations on prescription and consumption of Subutex® may be useful in preventing these complications, in addition to increasing public awareness and education of the risks of parenteral abuse for patients on cessation programme.

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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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Fungal spinal epidural abscess: a case series of nine patients

The Spine Journal ◽

10.1016/j.spinee.2018.08.001 ◽

2019 ◽

Vol 19 (3) ◽

pp. 516-522 ◽

Cited By ~ 6

Author(s):

Huiliang Yang ◽

Akash A. Shah ◽

Sandra B. Nelson ◽

Joseph H. Schwab

Keyword(s):

Epidural Abscess ◽

Case Series ◽

Spinal Epidural Abscess ◽

Spinal Epidural

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194. Antibiotic-resistant bloodstream infections in pediatric oncology patients on levofloxacin prophylaxis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.238 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S102-S102

Author(s):

Sunita Sridhar ◽

Anurag K Agrawal ◽

Lauren Ferrerosa ◽

Brian Lee ◽

Prachi Singh

Keyword(s):

Antibiotic Resistance ◽

Pediatric Oncology ◽

Case Series ◽

Bloodstream Infections ◽

Published Data ◽

Close Monitoring ◽

Oncology Patients ◽

Antibiotic Resistant ◽

Viridans Streptococcus ◽

Levofloxacin Prophylaxis

Abstract Background Levofloxacin prophylaxis in pediatric oncology patients with chemotherapy-induced severe prolonged neutropenia has been shown to reduce risk for febrile neutropenia and systemic infections. With increased use of prophylaxis there is concern for development of antibiotic-resistant infections. We analyzed bloodstream infections (BSI) in pediatric oncology patients exposed to levofloxacin prophylaxis during prolonged severe neutropenic episodes to determine the rate of antibiotic resistance Methods We performed a retrospective chart review of pediatric oncology patients who received levofloxacin prophylaxis between January 2015 – December 2019. Patients were placed on levofloxacin prophylaxis based on institutional guidelines for patients at risk for severe prolonged neutropenia (i.e., absolute neutrophil count [ANC] < 500 cells/µL for >7 days). Demographic information, start and end dates for levofloxacin prophylaxis, and all BSI episodes within 2 months after exposure to the fluoroquinolone were collected Results Thirty-five patients were identified who received levofloxacin prophylaxis. There were 32 BSI in 12 patients. Twenty-five BSI involved gram-positive organisms (GP), including nine (36%) due to coagulase negative Staphylococcus and seven (28%) due to viridans Streptococcus. Seven BSI episodes involved gram-negative (GN) organisms with 4 (57%) from E.coli. Resistance to fluroquinolones was noted in 42% and 48% of BSI from GN and GP organisms respectively. The vast majority (85%) of viridans Streptococcus isolates were resistant to levofloxacin. In contrast, 8% of viridans Streptococcus isolates were resistant to fluoroquinolones from the same time frame per our hospital antibiogram. Conclusion In this recent cohort of pediatric oncology patients with BSI after exposure to levofloxacin prophylaxis, there was a high percentage infected with fluoroquinolone-resistant organisms.This contrasts with some of the earlier published data from adults which reported low rate of fluoroquinolone resistance. This case series highlights the need for close monitoring for development of antibiotic resistance as utilization of prophylactic levofloxacin increases in pediatric oncology patients. Disclosures All Authors: No reported disclosures

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The indications and timing for operative management of spinal epidural abscess: literature review and treatment algorithm

Neurosurgical FOCUS ◽

10.3171/2014.6.focus14261 ◽

2014 ◽

Vol 37 (2) ◽

pp. E8 ◽

Cited By ~ 42

Author(s):

Alexander Tuchman ◽

Martin Pham ◽

Patrick C. Hsieh

Keyword(s):

Literature Review ◽

Medical Management ◽

Epidural Abscess ◽

Nonoperative Management ◽

Treatment Algorithm ◽

Case Series ◽

Spinal Epidural Abscess ◽

Pubmed Database ◽

Cord Injury ◽

Spinal Epidural

Object Delayed or inappropriate treatment of spinal epidural abscess (SEA) can lead to serious morbidity or death. It is a rare event with significant variation in its causes, anatomical locations, and rate of progression. Traditionally the treatment of choice has involved emergency surgical evacuation and a prolonged course of antibiotics tailored to the offending pathogen. Recent publications have advocated antibiotic treatment without surgical decompression in select patient populations. Clearly defining those patients who can be safely treated in this manner remains in evolution. The authors review the current literature concerning the treatment and outcome of SEA to make recommendations concerning what population can be safely triaged to nonoperative management and the optimal timing of surgery. Methods A PubMed database search was performed using a combination of search terms and Medical Subject Headings, to identify clinical studies reporting on the treatment and outcome of SEA. Results The literature review revealed 28 original case series containing at least 30 patients and reporting on treatment and outcome. All cohorts were deemed Class III evidence, and in all but two the data were obtained retrospectively. Based on the conclusions of these studies along with selected smaller studies and review articles, the authors present an evidence-based algorithm for selecting patients who may be safe candidates for nonoperative management. Conclusions Patients who are unable to undergo an operation, have a complete spinal cord injury more than 48 hours with low clinical or radiographic concern for an ascending lesion, or who are neurologically stable and lack risk factors for failure of medical management may be initially treated with antibiotics alone and close clinical monitoring. If initial medical management is to be undertaken the patient should be made aware that delayed neurological deterioration may not fully resolve even after prompt surgical treatment. Patients deemed good surgical candidates should receive their operation as soon as possible because the rate of clinical deterioration with SEA is notoriously unpredictable. Although patients tend to recover from neurological deficits after treatment of SEA, the time point when a neurological injury becomes irreversible is unknown, supporting emergency surgery in those patients with acute findings.

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.439 ◽

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

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