Healthcare Associated Discitis in the Era of Antimicrobial Resistance

Lillie, Patrick; Thaker, Hiten; Moss, Peter; Baruah, Joy; Cullen, Lorraine; Taylor, D.; Barlow, Gavin

doi:10.1097/rhu.0b013e318181addd

Cited by 11 publications

(10 citation statements)

References 11 publications

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“…Empirical broad-spectrum antibiotic therapy was linked to increased resistance, post-antibiotic complications (e.g. Clostridium difficile-associated diarrhea) and health care costs [ 20 , 21 ]. As multi-resistant and atypical agents are increasingly recognized, identification of the microbial pathogen is needed for sensitivity testing and to tailor antibiotic therapy [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

CT-Guided Biopsy in Suspected Spondylodiscitis – The Association of Paravertebral Inflammation with Microbial Pathogen Detection

et al. 2016

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ObjectivesTo search for imaging characteristics distinguishing patients with successful from those with futile microbiological pathogen detection by CT-guided biopsy in suspected spondylodiscitis.Methods34 consecutive patients with suspected spondylodiscitis underwent CT-guided biopsy for pathogen detection. MR-images were assessed for inflammatory infiltration of disks, adjacent vertebrae, epidural and paravertebral space. CT-images were reviewed for arrosion of adjacent end plates and reduced disk height. Biopsy samples were sent for microbiological examination in 34/34 patients, and for additional histological analysis in 28/34 patients.ResultsParavertebral infiltration was present in all 10/10 patients with positive microbiology and occurred in only 12/24 patients with negative microbiology, resulting in a sensitivity of 100% and a specificity of 50% for pathogen detection. Despite its limited sensitivities, epidural infiltration and paravertebral abscesses showed considerably higher specificities of 83.3% and 90.9%, respectively. Paravertebral infiltration was more extensive in patients with positive as compared to negative microbiology (p = 0.002). Even though sensitivities for pathogen detection were also high in case of vertebral and disk infiltration, or end plate arrosion, specificities remained below 10%.ConclusionsInflammatory infiltration of the paravertebral space indicated successful pathogen detection by CT-guided biopsy. Specificity was increased by the additional occurrence of epidural infiltration or paravertebral abscesses.

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Section: Discussionmentioning

confidence: 99%

CT-Guided Biopsy in Suspected Spondylodiscitis – The Association of Paravertebral Inflammation with Microbial Pathogen Detection

et al. 2016

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“…Once a spinal infection is suspected, it is recommended to obtain blood and urine cultures before antibiotic initiation [21,43]. According to the main monomicrobial pattern of pyogenic spondylodiscitis, about up to 59 % of positive blood cultures identify the causative microorganism [4].…”

Section: Laboratory Findingsmentioning

confidence: 99%

Spinal infection: state of the art and management algorithm

2013

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“…This is specifically important in the era of increasing antimicrobial resistance. Empirical antibiotic therapy is highly discouraged before obtaining the proper specimens for cultures ( 46 , 47 ). Blood and wound cultures are recommended in patients presenting with suspected SSIs.…”

Section: Microbial Etiologymentioning

confidence: 99%

Surgical Site Infections Following Spine Surgery: Eliminating the Controversies in the Diagnosis

2014

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Surgical site infection (SSI) following spine surgery is a dreaded complication with significant morbidity and economic burden. SSIs following spine surgery can be superficial, characterized by obvious wound drainage or deep-seated with a healed wound. Staphylococcus aureus remains the principal causal agent. There are certain pre-operative risk factors that increase the risk of SSI, mainly diabetes, smoking, steroids, and peri-operative transfusions. Additionally, intra-operative risk factors include surgical invasiveness, type of fusion, implant use, and traditional instead of minimally invasive approach. A high level of suspicion is crucial to attaining an early definitive diagnosis and initiating appropriate management. The most common presenting symptom is back pain, usually manifesting 2–4 weeks and up to 3 months after a spinal procedure. Scheduling a follow-up visit between weeks 2 and 4 after surgery is therefore necessary for early detection. Inflammatory markers are important diagnostic tools, and comparing pre-operative with post-operative levels should be done when suspecting SSIs following spine surgery. Particularly, serum amyloid A is a novel inflammatory marker that can expedite the diagnosis of SSIs. Magnetic resonance imaging remains the diagnostic modality of choice when suspecting a SSI following spine surgery. While 18F-fluorodeoxyglucose-positron emission tomography is not widely used, it may be useful in challenging cases. Despite their low yield, blood cultures should be collected before initiating antibiotic therapy. Samples from wound drainage should be sent for Gram stain and cultures. When there is a high clinical suspicion of SSI and in the absence of superficial wound drainage, computed tomography-guided aspiration of paraspinal collections is warranted. Unless the patient is hemodynamically compromised, antibiotics should be deferred until proper specimens for culture are secured.

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Healthcare Associated Discitis in the Era of Antimicrobial Resistance

Cited by 11 publications

References 11 publications

CT-Guided Biopsy in Suspected Spondylodiscitis – The Association of Paravertebral Inflammation with Microbial Pathogen Detection

CT-Guided Biopsy in Suspected Spondylodiscitis – The Association of Paravertebral Inflammation with Microbial Pathogen Detection

Spinal infection: state of the art and management algorithm

Surgical Site Infections Following Spine Surgery: Eliminating the Controversies in the Diagnosis

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