Background: There are several open scientific questions regarding the optimal antibiotic treatment of spinal infections (SIs) with or without an implant. The duration of postsurgical antibiotic therapy is debated. Methods: We will perform two unblinded randomized controlled trials (RCTs). We hypothesize that shorter durations of systemic antibiotic therapy after surgery for SI are noninferior (10% margin, 80% power, α = 5%) to existing (long) treatment durations. The RCTs allocate the participants to two arms of 2 × 59 episodes each: 3 vs. 6 weeks of targeted postsurgical systemic antibiotic therapy for implant-free SIs or 6 vs. 12 weeks for implant-related SIs. This equals a total of 236 adult SI episodes (randomization scheme 1:1) with a minimal follow-up of 12 months. All participants receive concomitant multidisciplinary surgical, re-educational, internist, and infectious disease care. We will perform three interim analyses that are evaluated, in a blinded analysis, by an independent study data monitoring committee. Besides the primary outcome of remission, we will also assess adverse events of antibiotic therapy, changes of the patient's nutritional status, the influence of immune suppression, total costs, functional scores, and the timely evolution of the (surgical) wounds. We define infection as the presence of local signs of inflammation (pus, wound discharge, calor, and rubor) together with microbiological evidence of the same pathogen(s) in at least two intraoperative samples, and we define remission as the absence of clinical, laboratory, and/or radiological evidence of (former or new) infection. Discussion: Provided that there is adequate surgical debridement, both RCTs will potentially enable prescription of less antibiotics during the therapy of SI, with potentially less adverse events and reduced overall costs.
Conventional imaging techniques are routinely used in the diagnostic work-up of patients with suspected osteomyelitis or orthopaedic implant-associated infections. Hybrid nuclear medicine imaging techniques are a suitable alternative to routine imaging modalities as they provide anatomical and functional information within one procedure. Our study investigated the performance of antigranulocyte SPECT/CT using 99m Tc-labelled monoclonal antibodies in the diagnosis of osteomyelitis and orthopaedic implant-associated infections. Methods: In this retrospective analysis, we included patients with 99m Tc-antigranulocyte SPECT/CT acquired in the context of a suspected bone and joint infection. All patients underwent routine diagnostics and/or had a clinical follow-up of at least 12 months. Results: 26 episodes were included. Fifteen exams were performed for suspected osteomyelitis, and 11 for suspected orthopaedic implant-associated infection. SPECT/CT was ordered most often if standard diagnostic tests or conventional imaging modalities remained inconclusive. The overall sensitivity and specificity for the diagnosis of an infection were 77.8% and 94.1%, respectively. The positive predictive value was 87.5% and the negative predictive value 88.9%. Diagnostic accuracy was 88.5%. Conclusions: 99m Tc-antigranulocyte SPECT/CT imaging has a high accuracy in the diagnosis of osteomyelitis and orthopaedic implant-associated infections and is a suitable non-invasive diagnostic tool if standard diagnostic examinations are inconclusive or not applicable.
BACKGROUND Intra-operative muscle relaxation is often required in orthopaedic surgery and the hand train-of-four (TOF) test is usually used for its quantification. However, even though full muscle relaxation is claimed by anaesthesiologists based on a TOF count of zero, surgeons observe residual muscle activity. OBJECTIVE The aim of the study was to assess if hand or foot TOF adequately represents intra-operative muscle relaxation compared with multiple motor evoked potentials. DESIGN Prospective observational study. SETTING A single-centre study performed between February 2016
Background There are several open scientific questions regarding the optimal antibiotic treatment of spine infections (SI) with or without an implant. The duration of post-surgical antibiotic therapy is debated.Methods We will perform and perform two unblinded randomized -controlled RCTs. We hypothesize that shorter durations of systemic antibiotic therapy after surgery for SI are non-inferior (10% margin, 80% power, ɑlpha 5%) to existing (long) treatment durations. The RCTs allocate the participants in two arms of 2 x 59 episodes each: 3 vs. 6 weeks of targeted post-surgical systemic antibiotic therapy for implant-free spine infections (two positive microbiological samples); or 6 vs. 12 weeks for implant-related spine infections. This equals a total of 236 adult SI episodes (randomization schemes 1:1) with a minimal follow-up of 12 months. All participants have a concomitant multidisciplinary surgical, re-educational, internist and infectious diseases care. We perform three interim analyses that are evaluated, in a blinded analysis, by an independent Study Data Monitoring Committee. Besides the primary outcome remission, we also assess adverse events of antibiotic therapy, changes of the patient’s nutritional status, the influence of immune suppression, total costs, functional scores, and the timely evolution of the (surgical) wounds. We define infection as the presence of local signs of inflammation (pus, wound discharge, calor, rubor) together with microbiological evidence of the same pathogen(s) in at least two intraoperative samples; and remission as absence of clinical, laboratory and/or radiological evidence of (former or new) infection.Discussion Provided that there is adequate surgical debridement, both RCTs enable to potentially prescribe less antibiotics during the therapy of SI; with potentially less adverse events and reduced overall costs.
e13524 Background: Diagnosis and treatment of glioblastoma (GBM), the most common and aggressive malignant brain tumor in adults, impose profound chronic distress on patients and their partners. In order to assess how distress in patients and partners affects GBM outcome, we describe in a first step the level of distress – both biological and psychological – in patients and partners before and during standard radiochemotherapy -as measured by different assessment tools. Methods: Stress, measured by salivary cortisol levels (diurnal cortisol slope (DCS), cortisol awakening response (CAR)), copeptin serum level and distress thermometer (DT), perceived stress scale (PSS), anxiety/depression (HADS) and quality of life (FACT-G) was assessed prospectively in all patients with newly diagnosed GBM and their partners at 3 participating centers. The baseline measurements (T1), reported here, were taken immediately before start of standard first-line radiochemotherapy. Further follow-up is ongoing. The TOGETHER-Study with the primary aim to describe the impact of distress and exercise behavior on progression-free survival in GBM in patients and in a close partner was closed prematurely due to poor recruitment. Results: 12 patients and 11 partners were included. Pts were newly diagnosed with histologically confirmed GBM and immediately prior to starting radiochemotherapy with temozolomide. Age of pts in years (median = 62.5, range = 34-70), partners (median = 58, range = 47-79); sex (pts = all male/ partners = all female). Conclusions: Results from our small cohort lead to the hypothesis, that shortly after diagnosis and before start of radiochemotherapy partners of GBM patients seem to be more distressed than patients themselves -as assessed by DT and CAR. Clinical trial information: NCT02129335. [Table: see text]
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