scholarly journals Spondylodiscitis in Children: A Retrospective Study and Comparison With Non-vertebral Osteomyelitis

2021 ◽  
Vol 9 ◽  
Author(s):  
Marco Roversi ◽  
Gianluca Mirra ◽  
Antonio Musolino ◽  
Domenico Barbuti ◽  
Laura Lancella ◽  
...  
Keyword(s):  
Back Pain ◽  
Retrospective Study ◽  
Antibiotic Therapy ◽  
Broad Spectrum ◽  
Clinical Management ◽  
Clinical Remission ◽  
Vertebral Osteomyelitis ◽  
Site Specific ◽  
Early Start ◽  
Neurological Signs

Objectives: The aim of this study is to provide new data on pediatrics spondylodiscitis for an optimal clinical management of this site-specific osteomyelitis.Methods: We reported 48 cases of pediatric spondylodiscitis and made three comparisons between: (1) tubercular and non-tubercular cases; (2) patients aged more or less than 5 years; (3) children with spondylodiscitis and 62 controls with non-vertebral osteomyelitis.Results: A higher rate of sequelae was reported in patients with tubercular spondylodiscitis, but no significant differences were noted at the cut-off of 5 years of age. Compared to non-vertebral osteomyelitis, pediatric spondylodiscitis affects younger children of both genders, usually presenting with afebrile back pain, and requiring longer time to admission, hospitalization, and antibiotic therapy.Conclusion: Pediatric spondylodiscitis is an insidious disease with a non-specific presentation in childhood and peculiarities of its own. However, when clinical remission is obtained by an early start of broad-spectrum antibiotics, prolonging the therapy does not improve, nor worsens, the outcome. Surgical management is mandatory in case of vertebral instability and neurological signs but can be avoided when the infection is promptly treated with antibiotic therapy.

scholarly journals Clinical and Radiological Features Predicting Intervertebral Autofusion after Successful Antibiotic Therapy in Pyogenic Vertebral Osteomyelitis

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1349
Author(s):  
Insu Seong ◽  
Eunjung Kong ◽  
Ikchan Jeon
Keyword(s):  
Back Pain ◽  
Antibiotic Therapy ◽  
Fdg Pet ◽  
Soft Tissues ◽  
Vertebral Osteomyelitis ◽  
Fdg Uptake ◽  
Radiological Features ◽  
Group A ◽  
Pyogenic Vertebral Osteomyelitis ◽  
18F Fdg

Background: Pyogenic vertebral osteomyelitis (PVO) is a bacterial infection involving the intervertebral disc, vertebral body, and paravertebral soft tissues. Damaged intervertebral structure is a major cause of persistent back pain even after successful antibiotic therapy, which can be improved by achieving autofusion or via additional surgical fixation. In this study, we analyzed the clinical and radiological features predicting intervertebral autofusion after successful antibiotic therapy in lumbar PVO. Methods: This study was retrospectively conducted with 32 patients (20 men and 12 women) diagnosed with lumbar PVO that was completely cured with no recurrences after antibiotic therapy. They were divided into two groups with (group A, n = 18) and without (group B, n = 14) intervertebral autofusion at six-month follow-up. Differences in back pain, blood inflammatory markers, and radiological features of PVO on simultaneous 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG-PET/MRI) of the intervertebral structure between the two groups were analyzed. Results: The mean duration of antibiotic therapy was 41.44 ± 14.21 (21–89) days. Group A showed a statistically higher erythrocyte sedimentation ratio (ESR; 59.28 ± 32.33 vs. 33.93 ± 18.76 mm/h, p = 0.014; normal range of ESR < 25), maximum standardized 18F-FDG uptake (SUVmax; 5.56 ± 1.86 vs. 3.98 ± 1.40, p = 0.013), and sustained extensive edematous changes on T2-weighted fat saturation (T2FS) MRI (p = 0.015) immediately after successful antibiotic therapy. However, no significant differences were observed in back pain, C-reactive protein, or the distribution of 18F-FDG uptake/contrast enhancement on 18F-FDG-PET/MRI (p > 0.05). Conclusions: Higher ESR and SUVmax of the intervertebral structure and sustained extensive edematous change on T2FS MRI immediately after successful antibiotic therapy are related with subsequent intervertebral autofusion, which should be carefully considered when assessing therapeutic response in PVO.

scholarly journals Acute Pancreatitis Between Practice and Recommendations

2020 ◽  
Vol 4 (3) ◽  
pp. 561-567
Author(s):  
Boumediene Elhabachi ◽  
Abderrahman Blaha ◽  
Morsli Doulat ◽  
Hassan Cheheb ◽  
Soumia Zaouag
Keyword(s):  
Acute Pancreatitis ◽  
Retrospective Study ◽  
Enteral Nutrition ◽  
Antibiotic Therapy ◽  
Broad Spectrum ◽  
General Surgery ◽  
Early Phase ◽  
Broad Spectrum Antibiotic ◽  
The World ◽  
Surgery Department

Background:Acute inflammation of the pancreas, acute pancreatitis (AP) shows an increasing incidence in the world as well as in Algeria. However, lethality and mortality are decreasing, mainly due to recommendations from Atlanta, the International Pancreatology Association and the American Pancreatology Association. The purpose of this work was to analyze the management of AP in the general surgery department of the UHC of Sidi Bel Abbes. Method: In a retrospective study, 100 acute pancreatitis cases admitted to general surgery between January 2017 and December 2019 were analyzed. The abdominal scanner was systematic at the admission. The rate of lipasemia, when greater than 3 times the normal one, allowed, in association with the evocative pain, to make the diagnosis. The severity of AP was assessed using the Balthazar score. An MRI was requested when the scanner was inconclusive, to look for an etiology and / or possible complications. 79 (79%) patients received broad-spectrum antibiotic therapy and diet was systematic. Results: We have transmitted the recommendations of scholar societies to the various specialists and the management of AP is currently more unified and more effective. Scanner is no longer systematic in the early phase. Antibiotic therapy is no longer administered without biological evidence. Enteral nutrition is now possible. Conclusion: We were able to reach the goal of reducing hospitalization and scanning requests. A further analysis of 100 other PA files is planned to confirm the obtained results.

Development of an Electronic Definition for De-escalation of Antibiotics in Hospitalized Patients

2020 ◽  
Author(s):  
Rebekah W Moehring ◽  
Elizabeth S Dodds Ashley ◽  
Angelina E Davis ◽  
April Pridgen Dyer ◽  
Alice Parish ◽  
...  
Keyword(s):  
Critical Care ◽  
Retrospective Study ◽  
Soft Tissue ◽  
Antibiotic Therapy ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Time Points ◽  
Narrow Spectrum ◽  
Definition Of ◽  
Inpatient Units

Abstract Background Antimicrobial stewardship programs (ASPs) promote the principle of de-escalation: moving from broad- to narrow-spectrum agents and stopping antibiotics when no longer indicated. A standard, objective definition of de-escalation applied to electronic data could be useful for ASP assessments. Methods We derived an electronic definition of antibiotic de-escalation and performed a retrospective study among 5 hospitals. Antibiotics were ranked into 4 categories: narrow-spectrum, broad-spectrum, extended-spectrum, and agents targeted for protection. Eligible adult patients were cared for on inpatient units, had antibiotic therapy for at least 2 days, and were hospitalized for at least 3 days after starting antibiotics. Number of antibiotics and rank were assessed at 2 time points: day of antibiotic initiation and either day of discharge or day 5. De-escalation was defined as reduction in either the number of antibiotics or rank. Escalation was an increase in either number or rank. Unchanged was either no change or discordant directions of change. We summarized outcomes among hospitals, units, and diagnoses. Results Among 39 226 eligible admissions, de-escalation occurred in 14 138 (36%), escalation in 5129 (13%), and antibiotics were unchanged in 19 959 (51%). De-escalation varied among hospitals (median, 37%; range, 31–39%, P &lt; .001). Diagnoses with lower de-escalation rates included intra-abdominal (23%) and skin and soft tissue (28%) infections. Critical care had higher rates of both de-escalation and escalation compared with wards. Conclusions Our electronic de-escalation metric demonstrated variation among hospitals, units, and diagnoses. This metric may be useful for assessing stewardship opportunities and impact.

Facile syringe filter-enabled bacteria separation, enrichment, and buffer exchange for clinical isolation-free digital detection and characterization of bacterial pathogens in urine

The Analyst ◽  
2021 ◽  
Author(s):  
Pengfei Zhang ◽  
Aniruddha Kaushik ◽  
Kathleen E Mach ◽  
Kuangwen Hsieh ◽  
Joseph C. Liao ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Antibiotic Therapy ◽  
Broad Spectrum ◽  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Evidence Based ◽  
Pathogen Identification ◽  
Accelerated Methods ◽  
Syringe Filter

The development of accelerated methods for pathogen identification (ID) and antimicrobial susceptibility testing (AST) for infectious diseases is necessary to facilitate evidence-based antibiotic therapy and reduce clinical overreliance on broad-spectrum...

scholarly journals Back Pain in a 23-Year-Old Male With X-Linked Chronic Granulomatous Disease

2019 ◽  
Vol 6 (11) ◽  
Author(s):  
Michelle C Sabo ◽  
Michela Blain ◽  
Denise McCulloch ◽  
Heather L Glasgow ◽  
Dhruba J Sengupta ◽  
...  
Keyword(s):  
Back Pain ◽  
Invasive Aspergillosis ◽  
Chronic Granulomatous Disease ◽  
Vertebral Osteomyelitis ◽  
Aspergillus Species ◽  
Granulomatous Disease ◽  
First Case ◽  
Increased Risk

Abstract Patients with chronic granulomatous disease are at increased risk for invasive aspergillosis. Cryptic Aspergillus species are being increasingly recognized as distinct causes of infection in this population. In this study, we describe the first case of Aspergillus udagawae vertebral osteomyelitis in a patient with X-linked chronic granulomatous disease.

Does Hydrogen Peroxide Mouthwash Improve the Outcome of Secondary Post-Tonsillectomy Bleed? A 10-year Review

2005 ◽  
Vol 133 (2) ◽  
pp. 202-205 ◽  
Author(s):  
Irumee Pai ◽  
Stephen Lo ◽  
Satsuki Brown ◽  
Abbad G. Toma
Keyword(s):  
Hydrogen Peroxide ◽  
Retrospective Study ◽  
Study Design ◽  
Broad Spectrum ◽  
Pediatric Patients ◽  
Surgical Intervention ◽  
Control Group ◽  
Intravenous Antibiotics ◽  
The Common

Objective: To determine whether hydrogen peroxide (H2O2) mouthwash influences the outcome of secondary post-tonsillectomy hemorrhage in children. Study Design: Ten-year retrospective study of all children with secondary post-tonsillectomy hemorrhage. Setting: Tertiary otolaryngology center. Results: Of the 156 patients, 59 received H2O2 and 97 did not. All patients received broad-spectrum intravenous antibiotics. The average rehospitalization duration due to hemorrhage was 1.7 days (H2O2 group) and 1.6 days (control group). In the H2O2 group, 8.5% required surgery, compared with 10.3% in the control group. Further hemorrhage episodes requiring readmission occurred in 3.4% of the H2O2 group and 3.1% of controls. There was no difference between the 2 groups in rehospitalization duration ( P = 0.49), rate of surgical intervention ( P = 0.85), and rate of readmission with further hemorrhage ( P = 0.92). Conclusion: Hydrogen peroxide mouthwash does not improve the outcome of secondary post-tonsillectomy hemorrhage in pediatric patients. Significance: This study does not support the common practice of treating post-tonsillectomy hemorrhage with H2O2.

Recurrent Methicillin-Resistant Staphylococcus Aureus Osteomyelitis: Combination Antibiotic Therapy with Evaluation by Serum Bactericidal Titers

1995 ◽  
Vol 29 (7-8) ◽  
pp. 694-697 ◽  
Author(s):  
Sherrie L Aspinall ◽  
David M Friedland ◽  
Victor L Yu ◽  
John D Rihs ◽  
Robert R Muder
Keyword(s):  
Staphylococcus Aureus ◽  
Back Pain ◽  
Antibiotic Therapy ◽  
Sedimentation Rate ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Blood Cultures ◽  
Low Back ◽  
Methicillin Resistant ◽  
Trough Concentrations

Objective: To report on a patient with recurrent methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis and bacteremia successfully treated with combination antibiotic therapy. Case Summary: Two sets of blood cultures from a 55-year-old man with fever, malaise, and low back pain grew MRSA. Radiologic studies of the spine showed bony changes consistent with osteomyelitis. Soon after completing 6 weeks of vancomycin, the patient experienced a recurrence of back pain. Laboratory values included an increase in the sedimentation rate to 53 mm/h and positive blood cultures for MRSA. Vancomycin, gentamicin, and rifampin were administered for 8 weeks. Serum inhibitory and bactericidal titers were more than 1:1024 for both the peak and trough concentrations. Radiologic studies of the spine showed healing osteomyelitis. Two years after completion of antibiotic therapy, the infection has not recurred. Discussion: Antibiotic therapy alone was attempted because the patient was considered a risky surgical candidate. Serum inhibitory and bactericidal titers documented the high in vivo activity of the vancomycin, gentamicin, and rifampin combination. Initiation of vancomycin therapy led to disappearance of the fever and back pain. Cure was documented by sustained normalization of the erythrocyte sedimentation rate and radiologic evidence of healing. Conclusions: Combination antibiotic therapy with vancomycin, rifampin, and low-dose gentamicin (1 mg/kg q12h) may be useful for deep-seated tissue infection caused by MRSA.

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