Infection following percutaneous vertebral augmentation with polymethylmethacrylate.

Although the incidence of infection following vertebroplasty or kyphoplasty is rare, postoperative infection and cement augmentation in preexistent spondylitis can cause life-threatening complications in frail patients with notable comorbidities. In such cases, urgent culture and biopsy and the long-term use of proper antibiotics are necessary. PURPOSE: Infection following vertebral augmentation with polymethylmethacrylate (PMMA) is rare. We aimed to analyze 11 cases of pyogenic spondylitis and spondylodiscitis that occurred after vertebroplasty or kyphoplasty and to review similar cases in the literature. METHODS: All cases of postoperative spinal infections in our institution between January 2005 and November 2016 that primarily underwent percutaneous vertebroplasty or kyphoplasty were retrospectively reviewed. Eleven patients (mean age 76.3 years) were included. RESULTS: The incidence of infection following vertebroplasty/kyphoplasty was 0.36%. Postoperative infection occurred in 3 of 826 cases. All patients underwent combined surgical and antibiotic treatment because of neurologic deficit on the initial diagnosis of the infection or failure of prior medical treatment of the infection. The surgical procedure was thorough debridement of infected tissue and material including PMMA following anterior column reconstruction via anterior/posterior/combined approach in 10 patients and percutaneous pedicle screw fixation alone in 1 patient aged 96 years. The mean follow-up period was 21.1 months after the revision operation, excluding one patient who died 17 days after revision surgery. Ten patients recovered from infection. CONCLUSIONS: Although the incidence of infection following vertebroplasty or kyphoplasty is rare, postoperative infection and cement augmentation in preexisting spondylitis can develop into a life-threatening complication in frail patients with notable comorbidities. In treating infected vertebroplasty and kyphoplasty, immediate culture and biopsy and the long-term use of proper antibiotics are critical. Prompt surgical treatment should be considered in case of significant neurologic deficit, severe instability due to infected fracture, and resistance to antibiotics.

[Glucocorticoid therapy in rheumatoid arthritis - contra]. / Glukokortikoid-Therapie bei rheumatoider Arthritis ­ Contra.

Corticosteroids have a pleiotropic mechanism of action and influence a great number of cellular functions. This does not only result in a broad therapeutic effect, but in a large number of adverse events as well. It has been shown that about 60 % of all patients with rheumatoid arthritis in Germany are receiving corticosteroids and about every fifth of them more than the equivalence of 7.5 mg prednisone per day. Already small doses increase the risk f. e. for osteoporosis or cataract, as well as for severe infections. The benefit of a treatment with low dose corticosteroids in inhibiting the radiological erosivity of the disease is low and does not outweigh the risks.

Síndrome de DRESS como complicación de la antibioterapia en niños tratados por infecciones ortopédicas. A propósito de 2 casos / DRESS syndrome due to antibiotic therapy of osteoarticular infections in children: two case reports

La infección osteoarticular en el niño es frecuente por debajo de los 10 años. El tratamiento consiste en la administración de antibióticos y en algunos casos tratamiento quirúrgico. El tiempo de antibioterapia varía, desde 2 semanas para las artritis, hasta 6 semanas en casos de osteomielitis más abigarradas. Algunos de estos medicamentos poseen complicaciones individuales directas con baja repercusión clínica. Existen diferentes cuadros de hipersensibilidad a drogas descritos en la población infantil. El síndrome de DRESS consiste en una toxicodermia grave, que en ocasiones incluso puede comprometer la vida. Se caracteriza por fiebre elevada, mal estado general, adenopatías, y exantema. Desde el punto de vista clínico son síntomas superponibles a una exacerbación del proceso infeccioso previo por el que el paciente inició el tratamiento. Generalmente aparece afectación de órganos internos (sobre todo el hígado) y alteraciones hematológicas, que pueden hacer pensar en un cuadro séptico general. Presentamos dos casos de infección osteoarticular bacteriana en niños que fueron tratados con antibióticos y que presentaron este cuadro. Ambos regresaron tras la retirada de la medicación antibiótica (AU)

Osteoarticular infection in children frequently occurs before 10 years of age. Surgical drainage is sometimes required, whereas acute osteomyelitis can be treated with antibiotic therapy alone. The duration of antibiotic therapy varies, 2 weeks is sufficient for septic arthritis, whereas 6 weeks is often required for complicated cases. Some of these antibiotic drugs present direct complications with low clinical impact in certain individuals. Hypersensitivity to these drugs causes different reactions in children. DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe and potentially life-threatening drug reaction. It is characterised by high fever, malaise, lymphadenopathy and skin rash. From a clinical perspective, these symptoms can lead to an exacerbation of the initial infectious process for which treatment was commenced. The liver is the organ most often affected in DRESS syndrome associated with haematological changes, potentially similar to sepsis. We present two cases of children with osteoarticular infections who developed DRESS syndrome after antibiotic therapy. Both patients made a complete recovery after cessation of the antibiotic drugs used (AU)