RESUMO
Vancomycin-resistant enterococci (VRE) have recently emerged as an increasing concern in the management of severe infections. Treatment of these life-threatening infections has been limited to quinupristin-dalfopristin and, more recently, linezolid therapy. We report the first case, to our knowledge, of vancomycin-resistant Enterococcus faecium vertebral osteomyelitis treated successfully with quinupristin-dalfopristin. We review the recent epidemiology of VRE and briefly outline the pharmacology and pharmacokinetics of quinupristin-dalfopristin.
Assuntos
Antibacterianos/uso terapêutico , Enterococcus faecium/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Osteomielite/tratamento farmacológico , Resistência a Vancomicina , Virginiamicina/uso terapêutico , Idoso , Enterococcus faecium/isolamento & purificação , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Osteomielite/microbiologiaRESUMO
The effective thoracic and lumbar pedicle diameter as related to screw size for that pedicle was studied in six fresh-frozen human cadaver spines. Measurements of the pedicle were obtained before screw insertion using axial and coronal reformatted computed tomographic (CT) images, as well as graduated sounding of the pedicle. After sequentially loading each pedicle with increasingly larger screws, measurements were taken of the outer cortical diameters. Plastic deformation of the pedicle preceded pedicle fracture or cutout when the screw thread diameter became larger than the endosteal diameter or within 80% of the outer cortical diameter as measured from the CT scan. Pedicle screws did not obtain cortical purchase within the pedicle.
