218-OR: Does Antibiotic Treatment before Bone Biopsy Affect the Identification of Bacterial Pathogens from Bone Culture?

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 218-OR
Author(s):  
LAWRENCE A. LAVERY ◽  
EASTON C. RYAN ◽  
DAVID H. TRUONG ◽  
MATTHEW J. JOHNSON ◽  
JAVIER LA FONTAINE ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Bone Biopsy ◽  
Bacterial Pathogens ◽  
Bone Culture

scholarly journals Applying ecological resistance and resilience to dissect bacterial antibiotic responses

2018 ◽  
Vol 4 (12) ◽  
pp. eaau1873 ◽  
Author(s):  
Hannah R. Meredith ◽  
Virgile Andreani ◽  
Helena R. Ma ◽  
Allison J. Lopatkin ◽  
Anna J. Lee ◽  
...  
Keyword(s):  
Microbial Communities ◽  
Antibiotic Treatment ◽  
Bacterial Pathogens ◽  
Ecological Systems ◽  
Essential Property ◽  
Short Term ◽  
Bacterial Response ◽  
Ecological Resistance ◽  
Combination Treatments ◽  
Lactam Antibiotic

An essential property of microbial communities is the ability to survive a disturbance. Survival can be achieved through resistance, the ability to absorb effects of a disturbance without a notable change, or resilience, the ability to recover after being perturbed by a disturbance. These concepts have long been applied to the analysis of ecological systems, although their interpretations are often subject to debate. Here, we show that this framework readily lends itself to the dissection of the bacterial response to antibiotic treatment, where both terms can be unambiguously defined. The ability to tolerate the antibiotic treatment in the short term corresponds to resistance, which primarily depends on traits associated with individual cells. In contrast, the ability to recover after being perturbed by an antibiotic corresponds to resilience, which primarily depends on traits associated with the population. This framework effectively reveals the phenotypic signatures of bacterial pathogens expressing extended-spectrum β-lactamases (ESBLs) when treated by a β-lactam antibiotic. Our analysis has implications for optimizing treatment of these pathogens using a combination of a β-lactam and a β-lactamase (Bla) inhibitor. In particular, our results underscore the need to dynamically optimize combination treatments based on the quantitative features of the bacterial response to the antibiotic or the Bla inhibitor.

scholarly journals Primary Results of Bone Biopsies in Outpatients with Neuropathic Ulcers

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000 ◽  
Author(s):  
Alexandros Vris ◽  
Edward Massa ◽  
Raju Ahluwalia ◽  
Venu Kavarthapu
Keyword(s):  
Antibiotic Treatment ◽  
Bone Biopsy ◽  
Outpatient Setting ◽  
Limiting Factor ◽  
Anatomical Landmarks ◽  
Intact Skin ◽  
University Of Texas ◽  
Bone Biopsies ◽  
Foot Disease ◽  
Protective Sensation

Category: Diabetes Introduction/Purpose: Patients with Charcot foot disease often develop ulcers that probe to bone due to progressive deformity and loss of protective sensation. Infection of the ulcers and the underlying bone is common. In order to diagnose and treat osteomyelitis, especially in cases where reconstruction is planned, the pathogen must be isolated. The need for bone debridement and the duration of antibiotic treatment depends on the presence of bone infection. Percutaneous bone biopsies through intact skin is the gold standard for acquisition of samples for cultures. The presence of neuropathy negates the need for anaesthesia and renders biopsies possible in the outpatient setting. In our study we compare the results of bone biopsies with wound swabs and document the safety of the technique in clinic. Methods: Thirty five patients were included in the study. Inclusion criteria were the presence of neuropathy and foot ulcers with exposed bone (Grade 3 University of Texas wound classification). Samples were obtained by three different doctors with aseptic technique through intact skin and sent for cultures. The area of the bone where the sample was taken from was defined by the location of the ulcer, the available imaging and anatomical landmarks. Complications such as bleeding and entry point infection and delayed healing were documented. Superficial ulcer swabs were also obtained for comparison. Results: In 37 patients 2 procedures were abandoned due to pain; otherwise no complications during or after the biopsy were recorded and the procedure duration was 4 minutes at most. There was bacterial growth in 40% of bone biopsy samples, compared to 65.7% of superficial swabs. Cultures were polymicrobial in 35.7% of positive biopsies and 82.6% of positive ulcer swabs. Concordance between bone biopsy and swab results was seen in 16/35 (45.7%) of samples. In 7 patients both tests were negative and in 9 both positive. 7/9 of samples that were positive with both methods grew the same organism. Conclusion: Our study showed that there is poor concordance of the results of the two tests. Wound swabs have high rates of polymicrobial cultures; in comparision bone biopsies are more reliable in confirming a specific microbial organism and dictating the need for and type of antibiotic. Targeted antibiotics can thus be safely used, potentially reducing the complications and the cost of broad-spectrum antibiotic treatment. The technique of needle bone biopsy is easy, safe and reproducible, and pain is not a limiting factor for in outpatients with neuropathy.

scholarly journals Utility of Diagnostic Bone Biopsies in the Management of Osteomyelitis Through Retrospective Analysis: How Golden Is This Gold Standard?

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S91-S91
Author(s):  
Cole Hirschfeld ◽  
Shashi Kapadia ◽  
Joanna Bryan ◽  
Deanna Jannat-Khah ◽  
Benjamin May ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Gold Standard ◽  
Bone Biopsy ◽  
Antibiotic Use ◽  
Empiric Therapy ◽  
Bone Culture ◽  
Needle Size ◽  
Empiric Antibiotics ◽  
Bone Biopsies ◽  
Bone Cultures

Abstract Background Bone biopsy is considered the gold standard for diagnosis and treatment of osteomyelitis (OM), but few studies have investigated the extent to which it influences antimicrobial therapy in non-vertebral bones. The purpose of this study was to evaluate clinician-initiated changes to empiric antimicrobial therapy after obtaining bone biopsy results. A secondary aim was to identify predictors of a positive bone culture. Methods We retrospectively reviewed all cases of non-vertebral OM in patients who underwent image-guided bone biopsies between 2009 and 2016. Data on pathologic and microbiologic yield were collected and logistic regression was used to determine potential factors affecting the microbiologic yield. Post-biopsy empiric antibiotics and final antibiotics were compared with determine if there was a change in antibiotic treatment after biopsy results were reported. Results We evaluated 203 bone biopsies in 185 patients. Samples from 115 (57%) cases were sent to pathology, of which 33 (29%) confirmed OM. All samples were sent to microbiology and 57 (28%) yielded a positive result. Diabetes (OR=2.39, P = 0.021) and white blood cell count (OR=1.13, P = 0.006) were significantly associated with positive bone cultures in multivariate analyses. There was no association between positive cultures and number of samples cultured, needle size, prior antibiotic use, or antibiotic-free days. Post-biopsy empiric antibiotics were given in 138 (68%) cases. Therapy was narrowed to target specific organisms in seven cases and changed due to inadequate empiric treatment in three cases. Targeted therapy was initiated in 4/65 cases, in which empiric antibiotics had been initially withheld. While final antibiotics were withheld in 38/146 with negative bone cultures, empiric antibiotics were discontinued in only eight cases. Conclusion In patients with non-vertebral OM, bone biopsy cultures rarely yielded results that necessitated changes in antibiotic management. Identified bone organisms were treated by empiric therapy in most patients. While bone biopsy remains the gold standard diagnostic test for OM, further work is needed to identify patients whose management may be impacted by this procedure. Disclosures All authors: No reported disclosures.

scholarly journals Are surrogate markers for diabetic foot osteomyelitis remission reliable?

2020 ◽  
Author(s):  
Peter A Crisologo ◽  
Matthew Malone ◽  
Javier La Fontaine ◽  
Orhan Oz ◽  
Kavita Bhavan ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Diabetic Foot ◽  
Bone Biopsy ◽  
Surrogate Marker ◽  
Surrogate Markers ◽  
Bone Culture ◽  
Soft Tissue Infections ◽  
Diabetic Foot Infections ◽  
Index Site ◽  
Diabetic Foot Osteomyelitis

Background: The aim of this study was to evaluate surrogate markers commonly used in the literature for diabetic foot osteomyelitis remission after initial treatment for diabetic foot infections. Methods: Thirty-five patients with diabetic foot infections were prospectively enrolled and followed for 12 months. Osteomyelitis was determined from bone culture and histology initially and for recurrence. Chi square and Fischer's exact test were used for dichotomous variables and the student's t-test and Mann-Whitney U test for continuous variables with an alpha of 0.05. Results: Twenty-four patients were diagnosed with osteomyelitis and eleven patients with soft-tissue infections. 16.7% (n=) of patients with osteomyelitis had a re-infection based on bone biopsy. The success of osteomyelitis treatment varied based on the surrogate marker used to define remission: osteomyelitis infection (16.7%), failed wound healing (8.3%), re-ulceration (20.8%), re-admission (16.7%), amputation (12.5%). There was no difference in outcomes among patients who were initially diagnosed with osteomyelitis and soft tissue infections. There were no differences in osteomyelitis re-infection (16.7% vs 45.5%, p=0.07), wounds that failed to heal (8.3% vs 9.1%, p=0.94), re-ulceration (20.8% vs 27.3%, p=0.67), re-admission for diabetic foot infections at the same site (16.7% vs 36.4%, p=0.20), amputation at the same site after discharge (12.5% vs 36.4%, p=0.10). Osteomyelitis at the index site based on bone biopsy indicated that failed therapy was 16.7%. Indirect markers demonstrated a failure rate ranging from 8.3-20.8%. Conclusions: Most osteomyelitis markers were similar to markers in soft tissue infection subjects. Commonly reported surrogate markers were not shown to be specific to identify patients that failed osteomyelitis treatment when compared with patients that had soft tissue infections. Given this, these surrogate markers are not reliable for use in practice to identify osteomyelitis treatment failure.

scholarly journals Time-to-Report of the Bone Culture and Microbiologic Adequacy of Empiric Antibiotics in Patient’s with Diabetic Foot Osteomyelitis

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S94-S95
Author(s):  
Hyun Kyung Kim ◽  
Olga Vasylyeva
Keyword(s):  
Diabetic Foot ◽  
Bone Biopsy ◽  
Anaerobic Bacteria ◽  
Accurate Method ◽  
Bone Culture ◽  
Culture Result ◽  
Gram Positive ◽  
Diabetic Foot Infection ◽  
Superficial Wound ◽  
Diabetic Foot Osteomyelitis

Abstract Background Bone cultures in diabetic foot infection is the most accurate method to identify causative pathogen, while there is only 30% concordance between superficial wound swab and bone biopsy cultures. Diabetic foot infection is commonly polymicrobial, therefore report on the bone biopsy culture may come with several updates before it is finalized. Our study is aimed to describe how often additional pathogens were identified after patients’ discharge on antibiotics therapy for diabetic foot osteomyelitis, and evaluate microbiological appropriateness of antibiotic regimen upon discharge based on the final result of the bone culture. Methods Medical records of the patients 18 years old or older, who had inpatient bone biopsy, deep tissue debridement or amputation for diabetic foot infection, were reviewed from January 2014 through Dec 2015 in Rochester Regional Health System. Antibiotic regimens for the patients discharged before final culture result were evaluated for microbiological appropriateness by two reviewers trained in infectious diseases. Results In total, 198 procedures were screened, 158 procedures met inclusion criteria, out of which 74 patients with 80 procedures (51%) were discharged before the final culture result was available. Average time from procedure to the final culture report was 6 days, and from discharge to the final culture was 3.7 days. In most of the cases (70%, 56 out of 80) the patients were discharged on empiric regimen discordant with final culture result. Predominant organisms were Gram-positive bacteria 74%, with Gram negatives 24%, and yeast 2%. Most infections were polymicrobial (81%), mixed with anaerobic bacteria in 37%. The most frequent isolates were Staphylococcus aureus (15%), Corynebacterium (14%), anaerobic Gram-positive cocci (12%), and Staphylococcus epidermidis (8%). All negative Gram stains (31%, 25 out of 80) had positive growth on culture. Conclusion Half of the patients with diabetic foot osteomyelitis, who underwent bone biopsy, were discharged before final culture results were available. Most of them were discharged on empiric regimen discordant with final culture. This data suggests that careful outpatient follow-up on the final culture would likely result in modification of antibiotics therapy to target newly reported pathogen. Disclosures All authors: No reported disclosures.

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

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

scholarly journals Evolution of VIM-1-Producing Klebsiella pneumoniae Isolates from a Hospital Outbreak Reveals the Genetic Bases of the Loss of the Urease-Positive Identification Character

mSystems ◽  
2021 ◽  
Author(s):  
Nicolas Cabanel ◽  
Isabelle Rosinski-Chupin ◽  
Adriana Chiarelli ◽  
Tatiana Botin ◽  
Marta Tato ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Antibiotic Treatment ◽  
Multiple Scales ◽  
Bacterial Pathogens ◽  
Multidrug Resistant ◽  
Fitness Cost ◽  
Single Patient ◽  
Positive Identification ◽  
Hospital Outbreak ◽  
Or Gene

Evolution of multidrug-resistant bacterial pathogens occurs at multiple scales, in the patient, locally in the hospital, or more globally. Some mutations or gene acquisitions, for instance in response to antibiotic treatment, may be restricted to a single patient due to their high fitness cost.

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