ABSTRACT
Nosocomial infections after spinal surgery are relatively uncommon but potentially serious. The goal of diagnostic evaluation is to determine the extent of infection and identify the microorganism involved. Neuroimaging provides accurate information on correct topography, localization and propagation of the infection. Microbiological data are able to give aetiological causes. In this patient with severe, chronic polymicrobial spine infection with epidural abscess and CSF fistula due to multidrug-resistant organisms, the cure was achieved with long-term antimicrobial specific therapy with quinupristin-dalfopristin (50 days) and linezolid (100 days) with mild side effects. This positive result was due to combined medical and surgical treatment.
Subject(s)
Acetamides/therapeutic use , Anti-Bacterial Agents/therapeutic use , Cross Infection/drug therapy , Discitis/drug therapy , Epidural Abscess/drug therapy , Lumbar Vertebrae/microbiology , Oxazolidinones/therapeutic use , Prosthesis-Related Infections/drug therapy , Virginiamycin/therapeutic use , Bacteria/isolation & purification , Cerebrospinal Fluid/microbiology , Combined Modality Therapy , Cross Infection/etiology , Cross Infection/surgery , Curettage , Device Removal , Discitis/etiology , Discitis/surgery , Epidural Abscess/etiology , Epidural Abscess/surgery , Female , Fistula/cerebrospinal fluid , Fistula/etiology , Fistula/microbiology , Fluconazole/therapeutic use , Fungi/isolation & purification , Humans , Internal Fixators/adverse effects , Laminectomy , Linezolid , Meropenem , Methicillin Resistance , Middle Aged , Osteomyelitis/etiology , Osteomyelitis/microbiology , Parkinson Disease/complications , Prosthesis-Related Infections/etiology , Prosthesis-Related Infections/microbiology , Prosthesis-Related Infections/surgery , Reoperation , Skin Diseases/cerebrospinal fluid , Skin Diseases/etiology , Skin Diseases/microbiology , Spinal Diseases/cerebrospinal fluid , Spinal Diseases/etiology , Spinal Diseases/microbiology , Spinal Stenosis/complications , Spinal Stenosis/surgery , Staphylococcal Infections/drug therapy , Staphylococcal Infections/etiology , Staphylococcal Infections/surgery , Thienamycins/therapeutic useABSTRACT
OBJECTIVES: To investigate plasma and bone moxifloxacin concentrations following oral administration of a single or double dose of the drug, in order to consider its potential role in the treatment of osteomyelitis. PATIENTS AND METHODS: Thirty consecutive patients undergoing total knee arthroplasty were recruited. Three groups, of ten patients each, were formed: group A received moxifloxacin 400 mg orally 2 h (range 1.5-2.5) preoperatively, group B received moxifloxacin 400 mg orally 4 h (range 3.5-4.5) preoperatively and group C received moxifloxacin 400 mg orally 14 h preoperatively, followed by a second dose 2 h (range 1.5-2.5) preoperatively. During surgery, at the time of bone removal, a blood sample and aliquots of cortical and cancellous bone were collected and moxifloxacin concentrations were measured by HPLC. RESULTS: Mean plasma, cancellous bone and cortical bone concentrations were, respectively: 3.45, 1.89 and 1.43 mg/L for group A; 3.73, 1.81 and 1.56 mg/L for group B; and 6.26, 2.97 and 2.54 mg/L for group C. CONCLUSIONS: These data show a good penetration of moxifloxacin into both cancellous and cortical bone, with concentrations, after double dosing, exceeding the MIC90 for most pathogens involved in osteomyelitis and the clinic susceptibility breakpoint for Mycobacterium tuberculosis.
