Vertebral osteomyelitis after spine instrumentation surgery: risk factors and management.

BACKGROUND: Vertebral osteomyelitis after spine instrumentation surgery (pVOM) is a rare complication. Most cases of infection occur early after surgery that involve skin and soft tissue and can be managed with debridement, antibiotics, and implant retention (DAIR). AIM: To identify pVOM risk factors and evaluate management strategies. METHODS: From a multicentre cohort of deep infection after spine instrumentation (IASI) cases (2010-2016), pVOM cases were compared with those without vertebral involvement. Early and late infections were defined (<60 days and >60 days after surgery, respectively). Multivariate analysis was used to explore risk factors. FINDINGS: Among 410 IASI cases, 19 (4.6%) presented with pVOM, ranging from 2% (7/347) in early to 19.1% (12/63) in late IASIs. After multivariate analysis, age (adjusted odds ratio (aOR): 1.10; 95% confidence interval (CI): 1.03-1.18), interbody fusion (aOR: 6.96; 95% CI: 2-24.18) and coagulase-negative staphylococci (CoNS) infection (aOR: 3.83; 95% CI: 1.01-14.53) remained independent risk factors for pVOM. Cases with pVOM had worse prognoses than those without (failure rate; 26.3% vs 10.8%; P = 0.038). Material removal was the preferred strategy (57.9%), mainly in early cases, without better outcomes (failure rate; 33.3% vs 50% compared with DAIR). Late cases managed with removal had greater success compared with DAIR (failure rate; 0% vs 40%; P = 0.067). CONCLUSION: Risk factors for pVOM are old age, use of interbody fusion devices and CoNS aetiology. Although the diagnosis leads to a worse prognosis, material withdrawn should be reserved for late cases or when spinal fusion is achieved.

[Early detection and control of hospital malnutrition]. / Detección precoz y control de la desnutrición hospitalaria.

Over the last 25 years, hospital malnutrition has received attention by only a part of the medical staff who have been reporting that 25-50% of the hospitalized patients had some degree of malnutrition worsening during hospital stay. The causes of such high malnutrition rates, the reliability of the detection and nutritional assessment methodology and the clinical and financial consequences are established in all these reported studies. An early nutritional intervention on individuals at high risk would provide a better prognosis, improving the mortality and morbidity rates and reducing the hospital costs. Many programs for the nutritional assessment have been developed, some of which are being used in the clinical practice; the data collection requires a direct intervention upon the patients though, not being suitable to identify the nutrition risk of all the patients on admission. We are proving a tool to screen the nutritional status of all the hospitalized patients, in order to achieve a proper and early treatment of the malnutrition in relationship with the underlying disease, the course of hospitalization and the procedures of therapy.

Detección precoz y control de la desnutrición hospitalaria / Early detection and control of undernourishment in hospitals

La desnutrición de los pacientes hospitalizados ha sido motivo de atención para sólo una parte del colectivo médico en los últimos 25 años, dando lugar a la realización de múltiples estudios en los que, en general, se estima que entre el 25-50 por ciento de los pacientes ingresados en los hospitales tienen algún grado de desnutrición según las series, aumentando su incidencia durante el ingreso. En ellos se estudian las causas de esta elevada tasa de desnutrición en los hospitales, la utilidad y fiabilidad de los métodos de detección y evaluación, así como las consecuencias clínicas y económicas de esta situación perdurable. Una intervención nutricional precoz sobre pacientes de alto riesgo que pudieran ser detectados oportunamente, llevaría a un mejor pronóstico, mejorando las tasas de morbilidad, reingresos y mortalidad de nuestros pacientes, a la vez que propiciaría la disminución de los costes hospitalarios y sanitarios en conjunto. Se han desarrollado varios procedimientos para la valoración del estado de nutrición de diferentes colectivos de pacientes, alguno de los cuales se aplica en la práctica clínica. Pero todos requieren la intervención directa sobre el paciente a nivel de recogida de datos de anamnesis o exploración, por lo que ninguno de ellos es aplicable al control sistemático de la desnutrición en la totalidad de los pacientes atendidos en nuestros hospitales. Estamos ensayando una herramienta que permite el control epidemiológico permanente de la situación nutricional de los pacientes del ámbito hospitalario, con la finalidad de intervenir en la profilaxis y tratamiento precoz de la desnutrición relacionada con la enfermedad, la hospitalización o con los procedimientos terapéuticos (AU)

Over the last 25 years, hospital malnutrition has received attention by only a part of the medical staff who have been reporting that 25-50% of the hospitalized patients had some degree of malnutrition worsening during hospital stay. The causes of such high malnutrition rates, the reliability of the detection and nutritional assessment methodology and the clinical and financial consequences are established in all these reported studies. An early nutritional intervention on individuals at high risk would provide a better prognosis, improving the mortality and morbidity rates and reducing the hospital costs. Many programs for the nutritional assessment have been developed, some of which are being used in the clinical practice; the data collection requires a direct intervention upon the patients though, not being suitable to identify the nutrition risk of all the patients on admission. We are proving a tool to screen the nutritional status of all the hospitalized patients, in order to achieve a proper and early treatment of the malnutrition in relationship with the underlying disease, the course of hospitalization and the procedures of therapy (AU)