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 Although the diagnosis leads to a worse prognosis, material withdrawn should be reserved for late cases or when spinal fusion is achieved.

Ceftazidime-avibactam treatment in bacteremia caused by OXA-48 carbapenemase-producing Klebsiella pneumoniae.

Therapeutic options for bacteremia caused by carbapenem-resistant Enterobacterales (CRE) OXA-48-type are limited. The objective of this study was to analyze clinical success of CAZ-AVI compared with best available therapy (BAT) in patients with Klebsiella pneumoniae carbapenemase-producing OXA-48-type bacteremia (CRKp-OXA-48). We conducted a retrospective, single-center observational study in adult patients with CRKp-OXA-48 between December 2015 and May 2019. We collected the patients' clinical and epidemiological characteristics, antibiotic treatment (CAZ-AVI vs. BAT), and evolution. Factors associated with clinical success were analyzed using binary logistic regression. The study included 76 patients with CRKp-OXA-48-type bacteremia 33 received CAZ-AVI and 43 BAT. CAZ-AVI was mainly used in monotherapy (91%). Clinical success was more common in patients < 70-year-old (OR 4.79, 95% CI [1.435-16.002], p = 0.011) and CAZ-AVI treatment (OR 6.69, 95% CI [1.68-26.604], p = 0.007). Kaplan-Meier survival curve of 14-day mortality showed a lower mortality in patients who received CAZ-AVI (log rank 0.013). However, CAZ-AVI did not achieve statistical difference in IPTW for 14- and 30-day mortality (aOR 0.1, 95% CI [0.02-1.22], p = 0.076 and aOR 1.7, 95% CI [0.48-5.98], p = 0.413, respectively). CAZ-AVI treatment might be associated with a greater clinical success in CRKp-OXA-48 bacteremia.

Infección por Mycobacterium marinum / Infection by Mycobacterium marinum

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Intrasellar tuberculoma--a difficult diagnosis.

Tuberculosis is an exceptional cause of intrasellar mass lesion and diagnosis is usually established after histological examination following surgery. We report a 32-year-old woman with headache and amenorrhea, analytical features of hypopituitarism and an intrasellar mass lesion in radiological studies. A transsphenoidal approach was performed and tissue examination revealed pituitary tuberculoma. Additionally, we review the previously reported cases.

Pseudoaneurisma micótico por Mycobacterium tuberculosis / Mycotic pseudoaneurysm by Mycobacterium tuberculosis

La tuberculosis puede afectar a cualquier órgano de la economía, incluidas las arterias. Habitualmente esta afectación se produce por contigüidad de la arteria a un foco infeccioso adyacente, originándose fundamentalmente pseudoaneurismas.Describimos un caso de pseudoaneurisma tuberculoso de arteria ilíaca en probable relación con una peritonitis tuberculosa, que debutó como fiebre de origen desconocido. El diagnóstico de pseudoaneurisma se fundamentó en CT, confirmándose mediante estudio anatomopatológico y microbiológico obtenido en una primera intervención quirúrgica. A pesar del tratamiento tuberculostático, el paciente presentó rotura del pseudoa neurisma, lo que obligó a implantar un injerto. Creemos que no debe olvidarse la posibilidad de una afectación tuberculosa en un aneurisma micótico (AU)

[Prevalence of antiphospholipid syndrome in patients under 65 years of age with acute myocardial infarction]. / Prevalencia del síndrome antifosfolípido en pacientes menores de 65 años con infarto agudo de miocardio.

BACKGROUND: The antiphospholipid antibody syndrome (AAS), which is characterized by thromboembolic events and/or fetal loss and/or low platelet count associated with antiphospholipid antibodies, may evolve with acute myocardial infarction (AMI). The presence of AAS among young patients with AMI ranges from 14% to 21%, and this condition implies specific therapeutic attitudes as new thrombotic events may occur, according to some authors. MATERIALS AND METHODS: A prospective study was undertaken with 25 patients aged > or = 65 years with AMI that were admitted to our institution during one year who were compared with control patients with similar risk factors. IgG and IgM anticardiolipin antibodies (ACA) were measured in the first 24 hours since the onset of AMI symptoms and three months later. RESULTS: The follow-up ranged from three months to one year. Among patients, ACA positivity in the two measurements was higher (12%) than that observed in the control group (5%) (p = 0.36). ACA positivity on two occasions was not a risk factor for new thrombotic events. CONCLUSION: ACA positivity is higher among AMI patients (measured early and at three months) than among the general population although the presence of such antibodies does not increase the risk for new post-infarction thrombotic events.

Meningitis por Salmonella enteritidis

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Prevalencia del síndrome antifosfolípido en pacientes menores de 65 años con infarto agudo de miocardio / Prevalence of anti-phospholipid syndrome among patients aged less than 65 years with acute myocardial infarction

Introducción. El síndrome antifosfolípido (SAFL), caracterizado por fenómenos trombóticos y/o pérdidas fetales y/o plaquetopenia asociados a anticuerpos antifosfolípidos, puede cursar con infarto agudo de miocardio (IAM). La presencia de SAFL en pacientes jóvenes con IAM oscila entre el 14 por ciento y el 21 por ciento, patología que conlleva actitudes terapéuticas específicas al presentar en su evolución nuevos eventos trombóticos según algunos autores. Material y métodos. Se realiza un estudio prospectivo en 25 pacientes con IAM y edad inferior o igual a 65 años que ingresaron en nuestro centro a lo largo de un año, comparándolos con controles con factores de riesgo similares. Se determinan anticuerpos anticardiolipina (ACA) IgG e IgM en las primeras 24 horas desde el inicio de la clínica de IAM y a los tres meses. Resultados. El seguimiento osciló entre tres meses y un año. En el grupo de pacientes, la positividad de ACA en las dos determinaciones fue superior (12 por ciento) a la del grupo control (5 por ciento) (p = 0,36). La positividad de ACA en dos ocasiones no fue un factor de riesgo para nuevos eventos trombóticos. Conclusión. La positividad de ACA es superior en el grupo de pacientes con IAM (determinados precozmente y a los tres meses) que en la población general, si bien la presencia de dichos anticuerpos no incrementa el riesgo de nuevos eventos trombóticos postinfarto (AU)

[Mycotic pseudoaneurysm caused by Mycobacterium tuberculosis]. / Pseudoaneurisma micótico por Mycobacterium tuberculosis.

Mycobacterium tuberculosis can involve any organ of the body, including the arteries. Usually the mycobacteria infects the arterial wall spreading from a contiguous foci. We report a case of tuberculous pseudoaneurysm involving the iliac artery clinically manifested as fever of unknown origin. The diagnosis relied on abdominal CT-scanning. Tuberculous etiology was confirmed postoperatively by microbiologic and microscopic study. The antituberculous therapy was early started, but the patient died three months later as a consequence of a non-infectious abdominal aortic rupture. Clinicians should consider tuberculous etiology when the diagnosis of mycotic pseudoaneurysm is being entertained.