Postoperative instrumented spine infections: a retrospective review.

BACKGROUND: Postoperative infection following posterior instrumentation of the spine is not uncommon and is a potentially catastrophic complication. Removal of the instrumentation is ideal for eradicating infection. However, removal is not always possible from a structural standpoint. An alternative is to treat the patient with antibiotics in combination with irrigation and debridement. MATERIALS AND METHODS: All patients undergoing posterior instrumentation of the thoracolumbar spine from a single institution between 1996 and 2004 that developed an infection were retrospectively reviewed. The goal of this study was to determine the effectiveness of treating postoperative spinal instrument infections with antibiotics and irrigation and debridement alone without removal of the hardware. RESULTS: Out of a total of 737 spinal surgeries, 26 cases of postoperative infection were found. Nineteen of the patients had early onset infection, and 7 were late onset. Seventeen (90%) of the 19 patients with early onset infections successfully received long term antibiotics with initial retention of instrumentation. Six out of the 7 patients with late onset infection required removal of instrumentation for cure. All patients were considered cured with at least 36 months follow up with one patient still on oral antibiotics using this approach. CONCLUSIONS: The management of infected spinal instrumentation is dependent on the time of onset. Early onset infections can be successfully treated without instrumentation removal and 4-6 weeks of IV antibiotics followed by a course of oral antibiotics of 4-12 weeks. Late onset infections require instrumentation removal.

Cardiac tamponade in Still disease: a review of the literature.

Adult onset Still disease is an unusual multisystem inflammatory disorder of unknown etiology and pathogenesis. Among its protean manifestations is pericarditis which occurs in approximately 30-40% of patients. Cardiac tamponade is a rare complication of pericarditis occurring in the context of Still disease. We conducted a review of the English literature pertaining to the occurrence of pericardial tamponade in Still disease. We searched relevant journals and the PubMed Medline databases. A total of eighteen reported cases were identified; ten among children and eight in adults. Treatment of pericardial tamponade was medical therapy alone in two cases versus combined modality, medical and surgical drainage in the remainder of the cases. Outcomes were death among four of the ten children and there was no recurrence of tamponade in the remaining child and adult series. This review re-emphasizes the importance of considering Still disease in the differential diagnosis of the life-threatening emergency of pericardial tamponade.

Clinical significance of Aerococcus urinae: a retrospective review.

A retrospective chart review was performed on 54 patients with positive urine cultures during a 1-year period to assess the clinical significance of Aerococcus urinae. Based on predetermined criteria, patients were classified into 2 groups: those with urinary tract infections (UTIs) and those who were considered colonized. The majority of the patients were > or =65 years old and were female. Only 31% of patients with UTI and 45% of colonized patients had A. urinae isolated in pure cultures. Both groups had significant but similar underlying medical conditions, with urologic conditions being predominant. Significantly more patients in the UTI group had urinary catheters (P < .01). No direct complications or invasive disease was recognized in either group regardless of whether patients were treated with antibiotics. Apparently, A. urinae is a relatively avirulent organism when cultured from urine.

Fusarium osteomyelitis: case report and review of the literature.

We present a case of Fusarium osteomyelitis attributed to innocuous trauma in a patient with significant peripheral vascular disease and diabetes mellitus type 2. Fusarium species have been reported to cause an increasing number of infections, particularly in severely immunocompromized patients. Colonization of normal skin has also been reported. To the best of the author's knowledge, there are 5 cases of Fusarium osteomyelitis described in English-language literature. There is also a report with little detail of Fusarium infection involving bone in 3 patients with hematologic malignancy. We tabulated the pertinent facts of the 5 detailed cases and compared them to ours. Early diagnosis requires some suspicion of invasive fungal infection. Tissue culture and pathologic examination are necessary for definitive diagnosis and to distinguish infection from colonization. Therapy includes antifungal drugs and aggressive surgical debridement, and even when these modalities are readily implemented the outcome may not be optimal because of the angioinvasive character of the organism.

Disseminated Nocardia transvalensis infection with osteomyelitis and multiple brain abscesses.

A case of Nocardia transvalensis osteomyelitis and cerebral abscesses is described. To the authors' knowledge, the patient described here represents the first reported case of primary N. transvalensis leg abscess with contiguous osteomyelitis of the femur and secondary brain abscesses. The literature on nocardial osteomyelitis and cerebral nocardiosis is reviewed, and treatment of both conditions is discussed. The interactions between the immune system and nocardial organisms are described, as well as the host defense defects in diabetic patients as they relate to pathogenicity of the bacteria. Finally, the patient's paradoxical therapeutic response of resolving brain abscesses with concomitant unresolving osteomyelitis is discussed, as well as its implications for managing similar cases in the future.