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Xiao Y, Heck V, Hao L, Rauschmann M, Slavici A. Local antibiotic carriers in the surgical management of pyogenic spondylodiscitis : First comparative evaluation of gentamicin-loaded versus vancomycin-loaded efficacy. ORTHOPADIE (HEIDELBERG, GERMANY) 2025:10.1007/s00132-025-04657-0. [PMID: 40360715 DOI: 10.1007/s00132-025-04657-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/09/2025] [Indexed: 05/15/2025]
Abstract
OBJECTIVE To evaluate the efficacy of intraoperative gentamicin versus vancomycin-loaded PerOssal (Osartis, Münster, Germany) carriers on interbody fusion rates and infection control in patients undergoing surgery for pyogenic spondylodiscitis. METHODS This retrospective study included 29 patients with pyogenic spondylodiscitis who underwent surgical debridement, interbody fusion, and pedicle screw fixation between February 2018 and March 2023. Patients received PerOssal carriers loaded with either gentamicin (Group A, n = 14) or vancomycin (Group B, n = 15). Clinical outcomes, including fusion rates, infection control, complications, and inflammatory markers, were analyzed. RESULTS Baseline characteristics between groups were comparable. Fusion rates at 3-6 months' follow-up were 92.8% (13/14) in Group A and 80.0% (12/15) in Group B, without significant differences (P > 0.05). Both groups showed significant reductions in white blood cell counts and C‑reactive protein levels postoperatively, without inter-group differences (P > 0.05). Complications included cerebrospinal fluid leakage, hematoma, pulmonary embolism, and wound infections, all managed successfully with no recurrent infections observed. CONCLUSION In the short term, PerOssal carriers loaded with either gentamicin or vancomycin demonstrated effective infection control for pyogenic spondylodiscitis and high interbody fusion rates. Moreover, no apparent adverse effects on bone healing were associated with the local administration of high-concentration antibiotics.
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Affiliation(s)
- Yu Xiao
- Center for Spinal Surgery, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany.
- Department of Spinal Surgery, Fourth People's Hospital of Guiyang, Guiyang, China.
| | - Vincent Heck
- Center for Spinal Surgery, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedic, Trauma and Plastic Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Long Hao
- Department of Spinal Surgery, Fourth People's Hospital of Guiyang, Guiyang, China
| | - Michael Rauschmann
- Center for Spinal Surgery, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany
| | - Andrei Slavici
- Center for Spinal Surgery, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany
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Edelbach B, Glaser D, Almekkawi AK, Caruso JP, Sbaiti G, Aoun SG, Bagley CA. Optimal Duration of Antibiotic Therapy for Primary Osteomyelitis Discitis: A Systematic Review and Network Meta-Analysis. Spine (Phila Pa 1976) 2025; 50:636-644. [PMID: 39722225 DOI: 10.1097/brs.0000000000005244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 11/18/2024] [Indexed: 12/28/2024]
Abstract
STUDY DESIGN Systematic review and network meta-analysis. OBJECTIVE This study aimed to systematically review the literature on the management of primary osteomyelitis discitis and perform a network meta-analysis comparing the efficacy of different antibiotic treatment durations. BACKGROUND Primary osteomyelitis discitis is a challenging condition with varying management strategies. MATERIALS AND METHODS A comprehensive literature search was conducted. Studies reporting outcomes for the treatment of primary osteomyelitis discitis were included. A random-effect network meta-analysis was performed comparing antibiotic treatment durations of <4 weeks, 4 to 8 weeks, 8 to 12 weeks, and 12 to 16 weeks. The surface under the cumulative ranking curve (SUCRA) was used to rank treatment effectiveness. RESULTS Sixty-three articles with 4233 patients were included. Staphylococcus aureus was the most common causative agent (57.6%). The 4 to 8-week antibiotic duration ranked highest across fixed-effect and random-effect models (SUCRA: 0.8207 and 0.8343). The 12 to 16-week duration ranked highest in the fixed-effect model (SUCRA: 0.8460) but dropped substantially in the random-effect model (SUCRA: 0.3067). The <4-week duration showed mixed results. The 8 to 12-week duration consistently ranked lowest. No statistically significant differences were found between durations for symptomatic relief. CONCLUSION Antibiotic therapy for 4 to 8 weeks may provide the optimal balance of efficacy and treatment duration for most patients with primary osteomyelitis discitis. However, treatment should be individualized based on clinical response. Further prospective studies are needed to clarify optimal management strategies for this complex condition.
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Affiliation(s)
| | - Dylan Glaser
- Department of Neurosurgery, School of Medicine, University of Missouri-Kansas City
| | - Ahmad K Almekkawi
- Department of Neurosurgery, Saint Luke's Marion Bloch Neuroscience Institute, Kansas City, MO
| | - James P Caruso
- Department of Neurosurgery, The University of Texas Southwestern, Dallas, TX
| | - Ghewa Sbaiti
- Department of Pharmacy, The University of Texas Southwestern, Dallas, TX
| | - Salah G Aoun
- Department of Neurosurgery, The University of Texas Southwestern, Dallas, TX
| | - Carlos A Bagley
- Department of Neurosurgery, School of Medicine, University of Missouri-Kansas City
- Department of Neurosurgery, Saint Luke's Marion Bloch Neuroscience Institute, Kansas City, MO
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Kaiser S, Verboket RD, Frank J, Marzi I, Janko M. Effectiveness of combined local therapy with antibiotics and fibrin vs. vacuum-assisted wound therapy in soft tissue infections: a retrospective study. Eur J Trauma Emerg Surg 2024; 50:1559-1567. [PMID: 38466400 PMCID: PMC11458741 DOI: 10.1007/s00068-024-02483-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 02/20/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE Soft tissue infections can be severe and life-threatening. Their treatment consists currently in radical surgical wound debridement and combined systemic antimicrobial therapy. Different side effects are possible. Local antibiotic therapy represents a new approach to reduce side effects and improve healing. The aim of this study is to assess the effectiveness of the local sprayed use of antibiotics with fibrin sealing compared with negative pressure wound therapy as an established treatment of soft-tissue infections. METHODS In this retrospective study, patients with soft tissue infections who underwent surgical treatment were analysed. One group consists of patients, who received local fibrin-antibiotic spray (FAS) (n = 62). Patients treated by vacuum-assisted wound therapy (VAWT) as the established treatment were the control group (n = 57). Main outcomes were differences in the success of healing, the duration until healing and the number of needed operations. RESULTS Clinical healing could be achieved for 55 patients (98.21%) in the FAS group vs. 47 patients (92.16%) in the VAWT group (p = 0.19). Time to require this was 10.65 ± 10.38 days in the FAS group and 22.85 ± 14.02 days in the VAWT group (p < 0.001). In the FAS group, patients underwent an average of 1.44 ± 0.72 vs.3.46 ± 1.66 operations in the VAWT group (p < 0.001). CONCLUSION Compared to vacuum-assisted wound therapy in soft tissue infections, local fibrin-antibiotic spray shows faster clinical healing and less needed operations. Leading to shorter hospital stays and more satisfied patients. The combination of sprayed fibrin and antibiotics can be seen as a promising and effective method.
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Affiliation(s)
- S Kaiser
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Theodor‑Stern‑Kai 7, 60590, Frankfurt am Main, Germany
| | - R D Verboket
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Theodor‑Stern‑Kai 7, 60590, Frankfurt am Main, Germany.
| | - J Frank
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Theodor‑Stern‑Kai 7, 60590, Frankfurt am Main, Germany
| | - I Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Theodor‑Stern‑Kai 7, 60590, Frankfurt am Main, Germany
| | - M Janko
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Theodor‑Stern‑Kai 7, 60590, Frankfurt am Main, Germany
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Thavarajasingam SG, Vemulapalli KV, Vishnu K S, Ponniah HS, Vogel ASM, Vardanyan R, Neuhoff J, Kramer A, Shiban E, Ringel F, Demetriades AK, Davies BM. Conservative versus early surgical treatment in the management of pyogenic spondylodiscitis: a systematic review and meta-analysis. Sci Rep 2023; 13:15647. [PMID: 37730826 PMCID: PMC10511402 DOI: 10.1038/s41598-023-41381-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/25/2023] [Indexed: 09/22/2023] Open
Abstract
Spondylodiscitis is the commonest spine infection, and pyogenic spondylodiscitis is the most common subtype. Whilst antibiotic therapy is the mainstay of treatment, some advocate that early surgery can improve mortality, relapse rates, and length of stay. Given that the condition carries a high mortality rate of up to 20%, the most effective treatment must be identified. We aimed to compare the mortality, relapse rate, and length of hospital stay of conservative versus early surgical treatment of pyogenic spondylodiscitis. All major databases were searched for original studies, which were evaluated using a qualitative synthesis, meta-analyses, influence, and regression analyses. The meta-analysis, with an overall pooled sample size of 10,954 patients from 21 studies, found that the pooled mortality among the early surgery patient subgroup was 8% versus 13% for patients treated conservatively. The mean proportion of relapse/failure among the early surgery subgroup was 15% versus 21% for the conservative treatment subgroup. Further, it concluded that early surgical treatment, when compared to conservative management, is associated with a 40% and 39% risk reduction in relapse/failure rate and mortality rate, respectively, and a 7.75 days per patient reduction in length of hospital stay (p < 0.01). The meta-analysis demonstrated that early surgical intervention consistently significantly outperforms conservative management in relapse/failure and mortality rates, and length of stay, in patients with pyogenic spondylodiscitis.
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Affiliation(s)
- Santhosh G Thavarajasingam
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK.
- Department of Academic Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospital NHS Healthcare Trust, Cambridge, UK.
- Imperial Brain and Spine Initiative, Imperial College London, London, UK.
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany.
- Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany.
| | - Kalyan V Vemulapalli
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
| | - Sajeenth Vishnu K
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
| | - Hariharan Subbiah Ponniah
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
| | - Alexander Sanchez-Maroto Vogel
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
- Faculty of Medicine, Goethe-Universität Frankfurt, Frankfurt, Germany
| | - Robert Vardanyan
- Faculty of Medicine, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, UK
- Department of Academic Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospital NHS Healthcare Trust, Cambridge, UK
- Imperial Brain and Spine Initiative, Imperial College London, London, UK
| | - Jonathan Neuhoff
- Center for Spinal Surgery and Neurotraumatology, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Andreas Kramer
- Department of Neurosurgery, Universitätsmedizin Mainz, Mainz, Germany
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Ehab Shiban
- Department of Neurosurgery, Universitätsklinikum Augsburg, Augsburg, Germany
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Florian Ringel
- Department of Neurosurgery, Universitätsmedizin Mainz, Mainz, Germany
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Andreas K Demetriades
- Edinburgh Spinal Surgery Outcome Studies Group, Department of Neurosurgery, Division of Clinical Neurosciences, NHS Lothian, Edinburgh University Hospitals, Edinburgh, UK
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
| | - Benjamin M Davies
- Department of Academic Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospital NHS Healthcare Trust, Cambridge, UK
- Spondylodiscitis Study Group, EANS Spine Section, Hamburg, Germany
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Hijazi MM, Siepmann T, El-Battrawy I, Schröttner P, Podlesek D, Engellandt K, Schackert G, Juratli TA, Eyüpoglu IY, Filis A. The Efficacy of Daily Local Antibiotic Lavage via an Epidural Suction-Irrigation Drainage Technique in Spondylodiscitis and Isolated Spinal Epidural Empyema: A 20-Year Experience of a Single Spine Center. J Clin Med 2023; 12:5078. [PMID: 37568480 PMCID: PMC10420211 DOI: 10.3390/jcm12155078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Various treatment modalities are available for local antibiotic therapy in spondylodiscitis (SD) and isolated spinal epidural empyema (ISEE), but there is no evidence-based recommendation. Postoperative epidural suction-irrigation drainage (ESID) is thought to reduce bacterial load, which may prevent the development of relapse, wound healing, hematogenous spread, and systemic complications. We evaluated the efficacy of postoperative ESID over 20 years on disease progression and outcome in SD and ISEE. METHODS Detailed demographic, clinical, imaging, laboratory, and microbiological characteristics were examined in our cohorts of 208 SD and ISEE patients treated with and without ESID at a university spine center in Germany between 2002 and 2022. Between-group comparisons were performed to identify meaningful differences for the procedure. RESULTS We included data from 208 patients (142 SD, 68.3% vs. 66 ISEE, 31.7%) of whom 146 were ESID patients (87 SD, 59.6% vs. 59 ISEE, 40.4%) and 62 were NON-ESID patients (55 SD, 88.7% vs. 7 ISEE, 11.3%). ESID patients with SD showed more frequent SSI (ESID: 22, 25.3% vs. NON-ESID: 3, 5.5%, p = 0.003), reoperations due to empyema persistence or instability (ESID: 37, 42.5% vs. NON-ESID: 12, 21.8%, p = 0.012), and a higher relapse rate (ESID: 21, 37.5% vs. NON-ESID: 6, 16.7%, p = 0.037) than NON-ESID patients with SD. The success rate in NON-ESID patients with SD was higher than in ESID patients with SD (ESID: 26, 29.9% vs. NON-ESID: 36, 65.6%, p < 0.001). Multivariate binary logistic regression analysis showed that ESID therapy (p < 0.001; OR: 0.201; 95% CI: 0.089-0.451) was a significant independent risk factor for treatment failure in patients with SD. CONCLUSIONS Our retrospective cohort study with more than 20 years of experience in ESID technique shows a negative effect in patients with SD in terms of surgical site infections and relapse rate.
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Affiliation(s)
- Mido Max Hijazi
- Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Department of Neurosurgery, Division of Spine Surgery, Fetscherstrasse 74, 01307 Dresden, Germany; (D.P.); (G.S.); (T.A.J.); (I.Y.E.); (A.F.)
| | - Timo Siepmann
- Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Department of Neurology, Fetscherstrasse 74, 01307 Dresden, Germany;
| | - Ibrahim El-Battrawy
- Bergmannsheil University Hospitals Bergmannsheil, Ruhr University Bochum, Department of Cardiology, Bürkle de la Camp-Platz 1, 44789 Bochum, Germany;
| | - Percy Schröttner
- Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Institute for Microbiology and Virology, Fetscherstrasse 74, 01307 Dresden, Germany;
| | - Dino Podlesek
- Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Department of Neurosurgery, Division of Spine Surgery, Fetscherstrasse 74, 01307 Dresden, Germany; (D.P.); (G.S.); (T.A.J.); (I.Y.E.); (A.F.)
| | - Kay Engellandt
- Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Institute of Diagnostic and Interventional Neuroradiology, Fetscherstrasse 74, 01307 Dresden, Germany;
| | - Gabriele Schackert
- Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Department of Neurosurgery, Division of Spine Surgery, Fetscherstrasse 74, 01307 Dresden, Germany; (D.P.); (G.S.); (T.A.J.); (I.Y.E.); (A.F.)
| | - Tareq A. Juratli
- Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Department of Neurosurgery, Division of Spine Surgery, Fetscherstrasse 74, 01307 Dresden, Germany; (D.P.); (G.S.); (T.A.J.); (I.Y.E.); (A.F.)
| | - Ilker Y. Eyüpoglu
- Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Department of Neurosurgery, Division of Spine Surgery, Fetscherstrasse 74, 01307 Dresden, Germany; (D.P.); (G.S.); (T.A.J.); (I.Y.E.); (A.F.)
| | - Andreas Filis
- Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Department of Neurosurgery, Division of Spine Surgery, Fetscherstrasse 74, 01307 Dresden, Germany; (D.P.); (G.S.); (T.A.J.); (I.Y.E.); (A.F.)
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Kilinc F, Setzer M, Behmanesh B, Jussen D, Gessler F, Keil F, Kempf VAJ, Kessel J, Czabanka M, Prinz V. Safety and feasibility of outpatient parenteral antimicrobial therapy for patients with spinal infection. Sci Rep 2023; 13:6863. [PMID: 37100824 PMCID: PMC10133347 DOI: 10.1038/s41598-023-33502-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/13/2023] [Indexed: 04/28/2023] Open
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) is a cost-effective method of administering intravenous antimicrobial therapy. Although OPAT is well established in the UK and US healthcare systems, few centres in Europe perform it. Here we analysed OPAT for the treatment of patients with spinal infections at our institution. In this retrospective study, patients with spinal infection who required intravenous (i.v.) antimicrobial treatment between 2018 and 2021 were analysed. The duration of short-term antimicrobial treatment for skin and soft tissue infections and complex infections requiring long-term antimicrobial treatment, such as spinal bone or joint infections, were analysed. All patients were discharged with a peripherally inserted central catheter (PICC) line. Prior to discharge, all patients received training in the safe administration of their medications via the PICC line. The duration of OPAT and the rate of readmission after OPAT were analysed. For this study a total of 52 patients who were treated via OPAT due to spinal infections were analyzed. In 35 cases (69.2%) complex spinal infection was reason for i.v. antimicrobial therapy. Surgery was required in 23 of these 35 patients (65.7%). The average hospital stay for these patients was 12 ± 6 days. The remaining 17 patients were treated for an infection of the soft tissue or the skin and hospital stay for these patients was on average 8 ± 4 days. Gram-positive organisms were isolated in 64.4%. Staphylococcus aureus followed by other Staphylococcus species, was the most common detected organism. After discharging i.v. antimicrobial treatment was given for an average of 20 ± 14 days. The duration of antimicrobial treatment for soft tissue was 10.8 ± 8 days, and for complex infections 25.1 ± 18 days. The mean follow-up was 21 ± 14 months. There was one case of readmission due to treatment failure. There were no difficulties encountered in implementing OPAT. OPAT is a feasible and effective option for delivering intravenous antimicrobial therapy to patients with spinal infections who can be managed without hospitalisation. OPAT offers patient-centred treatment at home while avoiding the risks associated with hospitalisation, with high levels of patient satisfaction.
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Affiliation(s)
- Fatma Kilinc
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt Am Main, Germany.
| | - Matthias Setzer
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt Am Main, Germany
| | - Bedjan Behmanesh
- Department of Neurosurgery, University Medicine of Rostock, Rostock, Germany
| | - Daniel Jussen
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt Am Main, Germany
| | - Florian Gessler
- Department of Neurosurgery, University Medicine of Rostock, Rostock, Germany
| | - Fee Keil
- Department of Diagnostic and Interventional Radiology, Goethe University Hospital Frankfurt, Frankfurt Am Main, Germany
| | - Volkhard A J Kempf
- Department of Medical Microbiology, Goethe University Hospital, Frankfurt Am Main, Germany
| | - Johanna Kessel
- Department of Medicine, Infectious Diseases Unit, Goethe University Hospital, Frankfurt Am Main, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt Am Main, Germany
| | - Vincent Prinz
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt Am Main, Germany
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Is There a Difference in Clinical Features, Microbiological Epidemiology and Effective Empiric Antimicrobial Therapy Comparing Healthcare-Associated and Community-Acquired Vertebral Osteomyelitis? Antibiotics (Basel) 2021; 10:antibiotics10111410. [PMID: 34827348 PMCID: PMC8615006 DOI: 10.3390/antibiotics10111410] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 12/25/2022] Open
Abstract
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.
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Xiong G, Fogel H, Tobert D, Cha T, Schwab J, Bono C, Hershman S. Vancomycin-impregnated calcium sulfate beads compared with vancomycin powder in adult spinal deformity patients undergoing thoracolumbar fusion. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2021; 5:100048. [PMID: 35141614 PMCID: PMC8819864 DOI: 10.1016/j.xnsj.2020.100048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/16/2020] [Accepted: 12/23/2020] [Indexed: 10/26/2022]
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