minocycline and Discitis

A 73-year-old man on hemodialysis with a tunneled central venous catheter presented to the emergency room with a fever and severe back pain.. Physical examination, laboratory investigations, chest radiography, lumbar spine radiography, renal ultrasound, lumbosacral spine MRI and transthoracic echocardiography.. Spondylodiscitis as a result of methicillin-sensitive Staphylococcus aureus bacteremia.. Antibiotic therapy with intravenous cefazolin for 6 weeks and oral minocycline for 2 weeks.

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Catheterization, Central Venous; Catheters, Indwelling; Cefazolin; Discitis; Humans; Kidney Failure, Chronic; Magnetic Resonance Imaging; Male; Minocycline; Staphylococcal Infections

The incidence of infectious spondylodiscitis has been increasing over the last few years. This reflects the expanding elderly and immunocompromised populations and the rising implementation of invasive spinal procedures. Infection may be inoculated into the disc space directly during invasive spinal procedures. Osteomyelitis caused by Acinetobacter species is rare and mainly caused by multidrug-resistant strains.. We present the case of a 72-year-old Greek woman with postoperative spondylodiscitis caused by a multidrug-resistant Acinetobacter baumannii strain that was successfully treated, after she declined surgical treatment, with prolonged and high dosage of tigecycline. She received intravenously administered tigecycline 200 mg per day for 60 days and then 100 mg per day for a total of 102 days and was infection-free.. We reviewed the literature on the role of Acinetobacter baumannii as a cause of osteomyelitis, emphasizing the difficulty of treatment and the potential role of tigecycline in conservative treatment of the infection. We believe that 102 days in total is the longest time that any patient has received tigecycline in the literature, thus our patient is a unique case of successful treatment of spondylodiscitis.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Aged; Anti-Bacterial Agents; Discitis; Drug Administration Schedule; Drug Resistance, Multiple, Bacterial; Female; Humans; Minocycline; Tigecycline; Treatment Outcome

Tigecycline is a relatively new glycylcycline antimicrobial, active in vitro against a variety of Gram-positive and Gram-negative organisms. In this study we evaluated the outcomes of spondylodiscitis cases treated with tigecycline-including therapies retrospectively.. All adult (age >18 years) cases with a diagnosis of spondylodiscitis, who were treated with a tigecycline-including therapy between 2007 and 2011, were included in the study. The primary efficacy outcome was clinical success with tigecycline at the end of induction, while the secondary efficacy outcome was maintenance of success through 3 months following completion of induction.. A total of eight spondylodiscitis cases fulfilled the study inclusion criteria. All cases had back pain, restricted mobility, magnetic resonance findings associated with spondylodiscitis, and microbiology or pathological findings related to spondylodiscitis. All had post-neurosurgical spondylodiscitis. In five cases, tigecycline was started in accordance with the antibacterial susceptibility results from intervertebral tissue biopsy cultures, whereas in three it was started empirically. All cases had received several different antibacterials with failure before receiving tigecycline. The mean duration of tigecycline treatment was 37±21 days. One case was lost to follow-up after 2 days of tigecycline. Primary and secondary success was achieved in the remaining seven cases.. These limited data suggest that tigecycline may have a role in the treatment of refractory spondylodiscitis cases.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Blood Sedimentation; C-Reactive Protein; Discitis; Disease Management; Female; Follow-Up Studies; Humans; Male; Middle Aged; Minocycline; Neurosurgical Procedures; Postoperative Complications; Retrospective Studies; Tigecycline; Treatment Outcome

Topics: Anti-Bacterial Agents; Back Pain; Ceftazidime; Cephalosporins; Discitis; Female; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Middle Aged; Minocycline; Renal Dialysis; Ultrasonography