Is There a Difference in Clinical Features, Microbiological Epidemiology and Effective Empiric Antimicrobial Therapy Comparing Healthcare-Associated and Community-Acquired Vertebral Osteomyelitis?

Background: Empiric antibiotic therapy for suspected vertebral osteomyelitis (VO) should be initiated immediately in severely ill patients, and might be necessary for culture-negative VO. The current study aimed to identify differences between community-acquired (CA) and healthcare-associated (HA) VO in terms of clinical presentation, causative pathogens, and antibiotic susceptibility. Methods: Cases of adult patients with VO treated at a German university orthopaedic trauma center between 2000 and 2020 were retrospectively reviewed. Patient history was used to distinguish between CA and HA VO. Susceptibility of antibiotic regimens was assessed based on antibiograms of the isolated pathogens. Results: A total of 155 patients (with a male to female ratio of 1.3; and a mean age of 66.1 ± 12.4 years) with VO were identified. In 74 (47.7%) patients, infections were deemed healthcare-associated. The most frequently identified pathogens were Staphylococcus aureus (HAVO: 51.2%; CAVO: 46.8%), and Coagulase-negative Staphylococci (CoNS, HAVO: 31.7%; CAVO: 21.3%). Antibiograms of 45 patients (HAVO: n = 22; CAVO: n = 23) were evaluated. Significantly more methicillin-resistant isolates, mainly CoNS, were found in the HAVO cohort (27.3%). The highest rate of resistance was found for cefazolin (HAVO: 45.5%; CAVO: 26.1%). Significantly higher rates of resistances were seen in the HAVO cohort for mono-therapies with meropenem (36.4%), piperacillin–tazobactam (31.8%), ceftriaxone (27.3%), and co-amoxiclav (31.8%). The broadest antimicrobial coverage was achieved with either a combination of piperacillin–tazobactam + vancomycin (CAVO: 100.0%; HAVO: 90.9%) or meropenem + vancomycin (CAVO: 100.0%; HAVO: 95.5%). Conclusion: Healthcare association is common in VO. The susceptibility pattern of underlying pathogens differs from CAVO. When choosing an empiric antibiotic, combination therapy must be considered.

Download Full-text

Selection of an Appropriate Empiric Antibiotic Regimen in Culture-Negative Hematogenous Vertebral Osteomyelitis

10.1101/363549 ◽

2018 ◽

Author(s):

Ki-Ho Park ◽

Dong Youn Kim ◽

Yu-Mi Lee ◽

Mi Suk Lee ◽

Kyung-Chung Kang ◽

...

Keyword(s):

Antibiotic Susceptibility ◽

Tertiary Care ◽

Vertebral Osteomyelitis ◽

Retrospective Chart Review ◽

Oral Antibiotic ◽

Empiric Antibiotic ◽

Amoxicillin Clavulanate ◽

Healthcare Associated ◽

Susceptibility Profiles ◽

Culture Negative

AbstractThe aim of this study was to determine which antibiotic combinations are appropriate for culture-negative hematogenous vertebral osteomyelitis (HVO), based on the antibiotic-susceptibility pattern of organisms isolated from cases of culture-proven HVO. We conducted a retrospective chart review of adult patients with microbiologically proven HVO in five tertiary-care hospitals over a 7-year period. The appropriateness of empiric antibiotic regimens was assessed based on the antibiotic susceptibility profiles of isolated bacteria. In total, 358 cases of microbiologically proven HVO were identified. The main causative pathogens identified were methicillin-susceptible Staphylococcus aureus (33.5%), followed by methicillin-resistant S. aureus (MRSA) (24.9%), aerobic gram-negative bacteria (21.8%), and Streptococcus species (11.7%). Extended spectrum β-lactamase (ESBL)-producing Enterobacteriaceae and anaerobes accounted for only 1.7% and 1.4%, respectively, of the causative pathogens. Based on the susceptibility results of isolated organisms, levofloxacin plus rifampicin was appropriate in 73.5%, levofloxacin plus clindamycin in 71.2%, and amoxicillin-clavulanate plus ciprofloxacin in 64.5% of cases. These oral combinations were more appropriate for treating community-acquired HVO (85.8%, 84.0%, and 80.4%, respectively) than healthcare-associated HVO (52.6%, 49.6%, and 37.6%, respectively). Vancomycin combined with ciprofloxacin, ceftriaxone, ceftazidime, or cefepime was similarly appropriate (susceptibility rates of 93.0%, 94.1%, 95.8%, and 95.8%, respectively). In conclusion, in a setting with a high prevalence of MRSA HVO, oral antibiotic combinations may be suboptimal for treatment of culture-negative HVO and should be used only in patients with community-acquired HVO. Vancomycin combined with fluoroquinolone or a broad-spectrum cephalosporin was appropriate in most cases of HVO in this study.

Download Full-text

Antibiogram Development for an Outpatient Dialysis Center

Hospital Pharmacy ◽

10.1177/001857870003500314 ◽

2000 ◽

Vol 35 (3) ◽

pp. 251-254 ◽

Cited By ~ 4

Author(s):

Harold J. Manley ◽

George R. Bailie ◽

Marianne Neumann

Keyword(s):

Antibiotic Therapy ◽

Empiric Antibiotic Therapy ◽

Coagulase Negative Staphylococci ◽

Gram Positive ◽

Susceptibility Data ◽

Dialysis Center ◽

Antimicrobial Sensitivity ◽

Empiric Antibiotic ◽

Stage Renal Disease ◽

End Stage

Infection causes significant morbidity and mortality in end-stage renal disease patients. Despite recommendations to the contrary, vancomycin is often used empirically. Antibiograms may aid in the choice of empiric antibiotic therapy. We developed an antibiogram and determined the susceptibility of various microorganisms to cefazolin, gentamicin, and vancomycin. Retrospective review of culture results and susceptibility data from a 21-month time period were used to determine microorganism frequency of identification and antimicrobial sensitivity. A total of 362 microorganisms were identified and 285 cultures performed in 171 patients (144 hemodialysis; 27 peritoneal dialysis). Predominant organisms were coagulase-negative staphylococci (39.8%) and Staphylococcus aureus (24.6%). Gram-positive organisms accounted for 73.5% of isolates. Methicillin-resistant S. aureus and vancomycin-resistant Enterococcus were identified 3.8% and 2.3% of time, respectively. Gram-positive and negative microorganisms were frequently susceptible to cefazolin and gentamicin. Antibiogram interpretation indicates that cefazolin alone or in combination with gentamicin may be appropriate empiric antibiotic therapy in our outpatient dialysis center.

Download Full-text

Herpes Simplex Virus Laryngitis Presenting as Airway Obstruction: A Case Report and Literature Review

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489417699421 ◽

2017 ◽

Vol 126 (5) ◽

pp. 424-428 ◽

Cited By ~ 7

Author(s):

Lucas Harless ◽

Nancy Jiang ◽

Frank Schneider ◽

Megan Durr

Keyword(s):

Case Report ◽

Herpes Simplex Virus ◽

Herpes Simplex ◽

Literature Review ◽

Clinical Presentation ◽

Female Ratio ◽

Antiviral Medication ◽

Highly Effective ◽

Simplex Virus ◽

Male To Female

Objectives: Herpes simplex virus (HSV) laryngitis is rare in adults. We add a case report to the literature and perform a literature review to further delineate the clinical presentation, course, and treatment of HSV laryngitis in adults. Methods: Case report and literature review using PubMed and Ovid databases. Results: Ten cases of diagnosed HSV laryngitis in adults were reported in the literature. It is more common in immunocompromised patients. The mean patient age was 51 years with a male to female ratio of 1:1. The clinical presentation and course of HSV laryngitis is variable. Patients may have mild chronic symptoms, such as dysphonia, or a fulminant course with rapid airway compromise. On laryngoscopic exam, the most common findings are a white exudate or ulceration. The most common treatment is with antiviral medication, such as acyclovir, which tends to be highly effective. Conclusions: Herpes simplex virus laryngitis is rare. Clinical presentation of HSV laryngitis is variable, and its course may be indolent or fulminant. Treatment with antiviral medication tends to be highly effective.

Download Full-text

Sa1315 Appropriate Empiric Antibiotic Therapy of Community-Acquired and Healthcare-Associated Biliary Tract Infection

Gastroenterology ◽

10.1016/s0016-5085(15)30955-0 ◽

2015 ◽

Vol 148 (4) ◽

pp. S-290

Author(s):

Naoki Esaka ◽

Bunji Endo ◽

Osamu Fukuda ◽

Yoshinori Mizumoto ◽

Shinji Katsushima ◽

...

Keyword(s):

Tract Infection ◽

Antibiotic Therapy ◽

Biliary Tract ◽

Empiric Antibiotic Therapy ◽

Biliary Tract Infection ◽

Empiric Antibiotic ◽

Healthcare Associated

Download Full-text

An observational study of clinicoetiological profile of stroke patients in a new tertiary care hospital in North Odisha, India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20193401 ◽

2019 ◽

Vol 7 (8) ◽

pp. 3095

Author(s):

Bibhu P. Behera ◽

D. N. Maharana ◽

Partha S. Mohanty

Keyword(s):

Risk Factor ◽

Hemorrhagic Stroke ◽

Clinical Presentation ◽

Age Group ◽

Common Risk Factor ◽

Anterior Circulation ◽

Female Ratio ◽

Common Clinical Presentation ◽

Male To Female ◽

The Brain

Background: Stroke is one of the leading causes of morbidity and mortality in India. The objective was to study the clinical profile, risk factors, neurological characters, pattern of brain stroke, areas of brain affected as per CT scan findings in patients with stroke.Methods: This observational study was carried out from June 2018 to Jan 2019 of all new patients admitted with stroke in Pandit Raghunath Murmu Medical College and Hospital, Baripada, Mayurbhanj, Odisha, India.Results: The incidence of stroke is maximum in 46-60 years of age group. The average age+SD was 59.3+13.5 in our study. 274 (46.52%) patients had ischemic stroke and 315 (53.48%) patients had hemorrhagic stroke. The male to female ratio was 1.46:1. Anterior circulation (86.42%) was the most common territory involved in the brain. The most common risk factor was hypertension with 77.76% followed by dyslipidemia (53.99%). The most common clinical presentation was hemiplegia (85.23%).Conclusions: The incidence of stroke is maximum in 46-60 years of age group. The average age+SD was 59.3+13.5 in our study. 274 (46.52%) patients had ischemic stroke and 315 (53.48%) patients had hemorrhagic stroke. The male to female ratio was 1.46:1. Anterior circulation (86.42%) was the most common territory involved in the brain. The most common risk factor was hypertension with 77.76% followed by dyslipidemia (53.99%). The most common clinical presentation was hemiplegia (85.23%).

Download Full-text

Utility of Omentoplasty in Mediastinitis Treatment following Sternotomy

The Heart Surgery Forum ◽

10.1532/hsf.1511 ◽

2016 ◽

Vol 19 (6) ◽

pp. 265

Author(s):

Abdurrahim Colak ◽

Ugur Kaya ◽

Münacettin Ceviz ◽

Necip Becit ◽

Fehimcan Sevil ◽

...

Keyword(s):

Heart Surgery ◽

Subcutaneous Tissue ◽

Open Heart Surgery ◽

Open Heart ◽

Coagulase Negative Staphylococci ◽

Female Ratio ◽

Mediastinal Infection ◽

The Mean ◽

Age Range ◽

Male To Female

Background: Mediastinal infection is one of the most serious complications that occurs following open-heart surgery by sternotomy. In the present study, omentoplasty was initially and aggressively used to treat the infection and prevent the recurrence caused by bones in cases of mediastinitis following open-heart surgery at our clinic.Methods: Among the 3656 patients who underwent surgery at our department of cardiovascular surgery between January 1996 and December 2012, omentoplasty as a treatment for mediastinitis was applied to 19 (0.51%) patients (of which 13 were males) following sternotomy. The cases were revised on the 15th day following the first surgery and/or when there was a suspicion of mediastinal infection. The necrotic skin, subcutaneous tissue, and bone tissue were resected, and all the affected sternal tissues were removed until healthy hemorrhagic areas were reached. Results: The average age of the patients was between 49 and 81 years (mean: 65.7 ± 10.5 years). The mean age of the men was 66.08 ± 12.7 years (age range: 49-81 years) and that of the women was 63.2 ± 6.8 years (age range: 55-71 years). The male to female ratio was 2:1, and in both the male and female groups, the approximate age ranged from 55 and 70 years. In the intraoperative cultures received from wound cases, the most common agent of infection was methicillin-resistant coagulase-negative staphylococci. Purulent leaks from eight patients stopped in approximately 4 days. Purulent leaks from the other 11 patients continued until the 6th day, and thus, medical dressing also continued, after which the leaks stopped on the 15th day. The approximate postoperative hospital stay was 32 days (range: 13-63 days). Conclusion: Omentoplasty in heart surgery can be considered an effective method when used to control infection and treat secondary poststernotomy mediastinitis.

Download Full-text

Van der Woude Syndrome: Clinical Presentation in 64 Patients

The Cleft Palate-Craniofacial Journal ◽

10.1597/06-094.1 ◽

2007 ◽

Vol 44 (6) ◽

pp. 649-652 ◽

Cited By ~ 8

Author(s):

Jung-Ju Huang ◽

Jia-Woei Hou ◽

Ying-Chien Tan ◽

Kuo-Ting Chen ◽

Lun-Jou Lo ◽

...

Keyword(s):

Cleft Lip ◽

Clinical Presentation ◽

Cleft Lip And Palate ◽

Positive Family History ◽

Van Der Woude Syndrome ◽

Female Ratio ◽

Clinical Presentations ◽

Cleft Lip Palate ◽

Isolated Cleft Palate ◽

Male To Female

Objective: Van der Woude syndrome, characterized by lip pits and cleft lip/ palate, presents with variable expressions. This retrospective study was designed to obtain a better understanding of its clinical pattern in Taiwanese patients. Materials and Methods: Of 13,147 cleft patients treated at the Chang Gung Craniofacial Center from 1976 to 2004, there were 64 with Van der Woude syndrome. Clinical expressions and family histories were collected and analyzed. Results: The male to female ratio was 1:1. The majority had complete cleft types. Severe cleft was found among the patients, with 52% having bilateral cleft lip and palate, 31% having unilateral cleft lip and palate, and 17% having isolated cleft palate. A positive family history was found in 53.1% of the patients. The size, shape, location, and depth of the pits varied among patients. Conclusion: Clinical presentations did not always parallel those reported in the literatures. These differences warrant further investigation.

Download Full-text

Study of incidence and clinical presentation of tubercular abdominal emergencies

International Surgery Journal ◽

10.18203/2349-2902.isj20201165 ◽

2020 ◽

Vol 7 (4) ◽

pp. 1021

Author(s):

Mahendra Kumar

Keyword(s):

Clinical Presentation ◽

Uttar Pradesh ◽

Abdominal Tuberculosis ◽

Age Group ◽

Microsoft Excel ◽

Female Ratio ◽

Abdominal Emergencies ◽

History Of ◽

Subacute Intestinal Obstruction ◽

Male To Female

Background: Tuberculosis is a common surgical problem in our community. Emergency surgery is usually required and surgical procedure depends upon the location and extent of the disease. Objective of the study was to determine the incidence of abdominal emergencies due to tuberculosis.Methods: This observational study involved 300 patients with abdominal tuberculosis admitted either as a case of acute of subacute abdominal emergencies and tract in Lal Lajpath Rai hospital Kanpur, Uttar Pradesh, India, and associated hospitals. Data was entered into Excel worksheet and analyzed using SPSS version 16.0. Detailed data of each patient was entered on a Microsoft excel. Data were presented in number and percentages.Results: The maximum number of cases were in third decade of life, age group 21-30. There were 120 males and 180 females. Male to female ratio was 1:1.5. Most of cases not having evidence of tuberculosis. History of pulmonary tuberculosis and abdominal tuberculosis were observed in 25% and 13% of the total cases. Abdominal pain was the commonest symptoms. Generalized pain was present in 136 cases and localized pain was present in 154 cases. 186 cases were presented as subacute intestinal obstruction and 114 cases patients were presented as acute abdomen.Conclusions: Acute abdominal condition is one of the most frequent emergencies, early diagnosis with prompt treatment is essential for a promising prognosis.

Download Full-text

Orbital complications of ENT diseases

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20175627 ◽

2017 ◽

Vol 4 (1) ◽

pp. 210 ◽

Cited By ~ 1

Author(s):

Abhay Kumar ◽

Jitendra P. S. Chauhan ◽

Sunil K. S. Bhadouriya ◽

Bhartendu Bharti ◽

Prem Narain ◽

...

Keyword(s):

Early Diagnosis ◽

Vision Loss ◽

Clinical Presentation ◽

Surgical Intervention ◽

Correct Diagnosis ◽

Female Ratio ◽

Close Proximity ◽

Common Clinical Presentation ◽

Orbital Complications ◽

Male To Female

Background: Orbital complications are fairly common in Otorhinolaryngology practice because of close proximity of orbit to adjacent ENT regions. Orbital complications must be suspected whenever ENT patients present with complaints of proptosis, diplopia, vision loss and epiphora. Early diagnosis and treatment is necessary to prevent morbidity and mortality in these patients.Methods: This prospective study was conducted in the ENT department for a period of 1 year from August 2016 to July 2017 and comprised of 38 cases. This study was conducted to see the incidence, etiology, clinical, radiological and histopathological profile in relation to ophthalmic complications in ENT diseases. Results: Male to female ratio was 1.71:1. Patients mean age at presentation in present study was 39.71±19.86 (SD) years and maximum number of cases 10 (26.32%) were between 41-50 years of age. Among 38 patients of our series, most common clinical presentation was proptosis followed by nasal obstruction. Commonest ENT diseases responsible for orbital complications were the different sinonasal tumours comprising 18 cases, in which carcinoma maxilla constituted 6 cases.Conclusions: In conclusion, correct diagnosis, adequate antibiotic therapy, and surgical intervention are important for management of orbital and ophthalmic complications. Cooperation between Ophthalmologist and the Otolaryngologist is clearly desirable for proper management of these cases.

Download Full-text

Q Fever Vertebral Osteomyelitis Complicating Vertebroplasty

Rambam Maimonides Medical Journal ◽

10.5041/rmmj.10430 ◽

2021 ◽

Vol 12 (1) ◽

pp. e0007

Author(s):

Karina Dorfman ◽

◽

Ayelet Eran ◽

Nesrin Ghanem-Zoubi ◽

◽

...

Keyword(s):

Clinical Presentation ◽

Q Fever ◽

Acute Infection ◽

Vertebral Osteomyelitis ◽

Patient Treatment ◽

Vascular Prostheses ◽

Paravertebral Abscess ◽

Long Duration ◽

Chronic Q Fever ◽

Culture Negative

Query (Q) fever is a zoonotic bacterial infection caused by Coxiella burnetii. In a minority of patients, chronic disease can occur after acute infection. Endocarditis and infections of aneurysms or vascular prostheses are the most common forms of chronic Q fever in adults. We report a case of an elderly female patient with chronic Q fever vertebral osteomyelitis at the site of her previous cement vertebroplasty, complicated by paravertebral abscess. Patient treatment required prolonged drainage in addition to the long duration of antibiotic treatment by doxycycline and hydroxychloroquine. Osteomyelitis is a rare clinical presentation in adults with chronic Q fever. However, it is important to consider Q fever in the differential diagnosis of culture-negative osteomyelitis, especially in countries where C. burnetii is endemic, such as Israel.

Download Full-text