ro13-9904 and Discitis

To establish testing and treatment recommendations for a ceftriaxone once-daily dose regimen for systemic infections with Cutibacterium acnes.. A review of the literature and a retrospective evaluation of patients diagnosed with C. acnes spondylodiscitis and treated with ceftriaxone were performed. Ceftriaxone and penicillin MICs were determined for C. acnes isolates from blood and biopsies and the epidemiological cut-off (ECOFF) was determined with surveillance data from the UK Anaerobe Reference Laboratory in Cardiff.. Limited clinical data exist from endocarditis and prosthetic joint infections using treatment with ceftriaxone 2 g once daily for C. acnes with ceftriaxone MICs ≤0.5 mg/L. In this case study, five patients were successfully treated with ceftriaxone as part of the treatment for spondylodiscitis with C. acnes. Ceftriaxone and penicillin MICs of the C. acnes isolates from the patients were 0.016-0.125 mg/L and 0.012-0.032 mg/L, respectively. The ceftriaxone ECOFF was 0.5 mg/L and the penicillin ECOFF was 0.25 mg/L based on available surveillance data.. From the data presented in this study it would be acceptable to consider treatment with a once-daily dose of ceftriaxone 2 g for systemic infections, including endocarditis, spondylodiscitis and prosthetic joint infections with C. acnes using a clinical breakpoint of ≤0.5 mg/L (the ECOFF). However, clinical data are still limited and the response of patients treated with ceftriaxone for serious infections with C. acnes should be monitored closely.

Topics: Ceftriaxone; Discitis; Gram-Positive Bacterial Infections; Humans; Propionibacterium acnes; Retrospective Studies

Spondylodiscitis is an unusual diagnosis among children and consequent abscess formation is even rarer. A 6-year-old girl with fever, hip pain, and refusal to walk was evaluated. The neurologic examination was normal. Recurrent joint pain with cold weather, iron for anemia without improvement, and decreased intervertebral spaces raised the use of ceftriaxone, oxacillin, and external immobilization. Hemoglobin sickle cell disease, spondylodiscitis with paravertebral collections, and epidural abscess were documented. She was fully recovered. The treatment was conservative because there was no neurologic deficit. We add to the literature 1 case of spondylodiscitis with epidural abscess that was successfully treated with antibiotics alone.

Topics: Anemia, Sickle Cell; Anti-Bacterial Agents; Ceftriaxone; Child; Discitis; Epidural Abscess; Female; Humans; Lower Extremity; Oxacillin; Pain; Pain Management; Radiography; Remission Induction

Topics: Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Discitis; Humans; Lumbar Vertebrae; Male; Neisseria meningitidis; Young Adult

Infected aortic aneurysm is a rare disease and is often overlooked as a source of infection in septic elderly patients. We present a case of a septic elderly man with a ruptured infected aortic aneurysm caused by

Topics: Aged, 80 and over; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Abdominal; Back Pain; Ceftriaxone; Discitis; Drainage; Endovascular Procedures; Humans; Male; Psoas Abscess; Salmonella enteritidis; Sepsis; Tomography, X-Ray Computed

Topics: Administration, Intravenous; Administration, Oral; Aged; Anti-Bacterial Agents; Biopsy; Bone and Bones; Ceftriaxone; Diagnosis, Differential; Discitis; Female; Firmicutes; Humans; Magnetic Resonance Imaging; Metronidazole; Psoas Abscess; Treatment Outcome

A 42-year-old woman presented to our hospital with weeks of worsening pain around her lower ribs. Preceding this, she was managed in primary care with anti-inflammatory drugs and physiotherapy for presumed costochondritis. Assessment in accident and emergency suggested a tender right upper quadrant with fever and neutrophilia. A surgical review of the patient was requested to assess for cholecystitis or delayed pancreatitis. On direct questioning, the patient's back pain was the predominating symptom with no neurological deficit. To assess for delayed pancreatitis, CT imaging was obtained, demonstrating unremarkable intra-abdominal organs. There was also the incidental finding of thickened prevertebral soft tissues anterior to T9 and T10 vertebrae, with vertebral endplate irregularity locally. Subsequent MRI demonstrated typical appearances of infective spondylodiscitis at this level. The patient made a good recovery with intravenous antimicrobials. This case highlights how vertebrodiscitis can present insidiously and unexpectedly, manifesting as abdominal pain.

Topics: Abdominal Pain; Administration, Intravenous; Adult; Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Discitis; Female; Humans; Magnetic Resonance Imaging; Thoracic Vertebrae; Treatment Outcome

Extraintestinal Salmonella infection involving the thoracic spine is very rare. It commonly presents with non-specific chronic back pain and can occur with no gastrointestinal manifestation. Blood test results and imaging findings are often indistinguishable from more common chronic spine infections such as spine tuberculosis. Culture studies remain the key to establishing a definitive diagnosis and subsequently successful treatment. We report a case in which a patient presented with symptoms and signs suggestive of spine tuberculosis, yet the culture examination revealed otherwise.

Topics: Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Discitis; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Salmonella; Salmonella Infections; Thoracic Vertebrae; Tomography, X-Ray Computed; Tuberculosis, Spinal

Septic discitis is a rare but important cause of spinal pain caused by intervertebral disc infection. This retrospective observational case series analysis will examine the clinical features and management of septic discitis in 23 patients and compare with a similar 2001 study. We will also review the evidence behind management recommendations to identify areas for future research. The incidence of septic discitis was 2 per 100,000 per year. Patients presented with spinal pain (96 %), fever (70 %) and raised inflammatory markers. All patients had blood cultures and 52 % had targeted microbiological analysis. Staphylococcus aureus was the most common causative organism (39 %). Treatment was most often with intravenous flucloxacillin or ceftriaxone. CT-guided sampling for culture before commencing antibiotics increased organism detection from 33 to 67 %, and organism identification reduced the antibiotic course from an average of 142 days to 77 days. An increased number of significant co-morbid conditions were associated with worse outcomes. Results broadly resembled the 2001 study. Key differences were increased use and yield of magnetic resonance imaging and computerised tomography (CT) scanning and more frequent use of intravenous antibiotics. Comparisons between the studies suggest that improvements in the consistency of management have been slow. We suggest this due to the large spectrum of disease and the lack of guidelines in the UK. It is widely recommended to perform blood cultures and CT-guided biopsies before starting antibiotics, but it is unclear how long to withhold antibiotics if cultures remain negative. Six weeks of intravenous followed by 6 weeks of oral therapy is often suggested as treatment, whereas some recommend using inflammatory markers to guide antibiotic duration. Larger studies addressing these specific questions are required to provide more definitive guidance for these clinical decisions.

Topics: Anti-Bacterial Agents; Ceftriaxone; Discitis; Floxacillin; Humans; Retrospective Studies; Sepsis; Staphylococcal Infections; Staphylococcus aureus

Topics: Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Abdominal; Bacteremia; Cefazolin; Ceftriaxone; Discitis; Drainage; Humans; Levofloxacin; Male; Middle Aged; Psoas Abscess; Renal Dialysis; Staphylococcal Infections; Staphylococcus aureus

Spondylodiscitis, which is most commonly caused by Staphylococcus aureus, is an uncommon infection in adults. The diagnosis of spondylodiscitis is often delayed by its vague and non-specific presentations. As part of the normal flora in human mouth and sinuses, Streptococcus mitis is a very rare cause of spondylodiscitis. We report a case of thoracic spondylodiscitis caused by S. mitis in a patient with chronic sinusitis. The patient atypically presented with a sharp chest pain that radiated to the back and the imaging studies were initially negative. He failed outpatient pain management and the diagnosis of spondylodiscitis was confirmed by bone biopsy 6 weeks later. Treatment with antibiotics completely alleviated the pain. Increased awareness and a high index of suspicion are essential for early diagnosis of spondylodiscitis with an atypical presentation.

Topics: Anti-Bacterial Agents; Biopsy, Needle; Ceftriaxone; Chest Pain; Chronic Disease; Diagnosis, Differential; Discitis; Emergency Service, Hospital; Humans; Immunohistochemistry; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Middle Aged; Pain Measurement; Severity of Illness Index; Sinusitis; Streptococcal Infections; Streptococcus mitis; Thoracic Vertebrae; Treatment Outcome; Vancomycin

Topics: Administration, Intravenous; Anti-Bacterial Agents; Blood Sedimentation; C-Reactive Protein; Ceftriaxone; Discitis; Drug Administration Schedule; Drug Monitoring; Female; Humans; Image-Guided Biopsy; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging; Range of Motion, Articular; Salmonella Infections; Salmonella typhimurium; Treatment Outcome; Young Adult

Topics: Aged; Anti-Bacterial Agents; Aortic Valve; Ceftriaxone; Ciprofloxacin; Discitis; Endocarditis, Bacterial; Humans; Intervertebral Disc Degeneration; Male; Neisseria sicca; Neisseriaceae Infections; Penicillinase; Thoracic Vertebrae

Five years ago a 52-year-old patient presented with arthritis of the small and large joints. Further symptoms were relapsing fever, unspecific gastrointestinal complaints with meteorism but no diarrhea, fatigue and impaired concentration. Subsequently increasing lower back pain developed. A lumbar-disc lesion was already known.. Inflammatory markers were elevated including leucocytosis. Gastroscopy with intestinal biopsies and colonoscopy remained without pathologic findings. Whipple's disease was excluded, but unspecific lymphozyte infiltration of the duodenal mucosa was described. Magnetic resconance imaging of the lumbar spine showed spondylodiscitis in L3/4 which was punctured, and polymerase chain reaction revealed Tropheryma whipplei DNA. Retrospectively, this was also found in the intestinal biopsies of three years ago.. After initial exclusion of Whipple's disease an unspecific systemic inflammatory disease had been presumed, and the patient had been treated with immunomodulatory therapies in alternating combinations. Steroids improved the symptoms but an increasing dosage of steroids was required. After the detection of Tropheryma whipplei and diagnosis of Whipple's disease the patient received ceftriaxon for a period of two weeks, subsequently cotrimoxazol for one year. Inflammatory activity decreased but unspecific symptoms remained almost unaffected.. The differential diagnosis in patients with fever, elevated inflammatory markers and gastrointestinal symptoms must include Whipple's disease. A Tropheryma whipplei PCR from duodenal biopsies should be performed because of its higher sensitivity compared to histology alone.

Topics: Anti-Bacterial Agents; Biopsy, Needle; Ceftriaxone; Diagnosis, Differential; Discitis; DNA, Bacterial; Duodenum; Fever of Unknown Origin; Humans; Intestinal Mucosa; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Polymerase Chain Reaction; Rheumatic Diseases; Tomography, X-Ray Computed; Tropheryma; Whipple Disease

Discography is a controversial diagnostic procedure involving the injection of radiographic contrast medium (RCM) into the intervertebral disc. Iatrogenic bacterial discitis is a rare but serious complication. The intervention has been increasingly performed in our patients here in the United Arab Emirates. Prophylactic intravenous antibiotic administration can reduce post-interventional discitis; however, this may favour the development of bacterial resistance. Direct intradiscal injection of an antibiotic together with the RCM is a potential alternative. To date, there has been only one study on the efficacy of antibiotics added to an RCM. Equally, there are only limited data regarding the potential direct effect of RCM on bacterial growth. The purpose of this study was to determine whether the efficacy of antibiotics is affected when RCM are added. In an in vitro study, the effect of non-ionic RCM on the growth of five laboratory bacterial strains, alone and in combination with three broad-spectrum antimicrobials, was tested. Bacterial growth was assessed in the absence and the presence of RCM, antibiotics and their combinations. All three RCM alone demonstrated some inhibition of bacterial growth at high concentrations. In the presence of the RCM, all three antibiotics retained their inhibitory effect on bacterial growth. In conclusion, our in vitro experiments did not reveal any changes in the antimicrobial efficacy of the three antibiotics in the presence of the three tested RCM. Subsequent clinical trials will need to assess whether intradiscal antibiotic administration may be a suitable substitute for, or a supplement to, prophylactic systemic antibiotics before discography.

Topics: Ampicillin; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Ceftriaxone; Contrast Media; Discitis; Dose-Response Relationship, Drug; Drug Interactions; Escherichia coli; Gentamicins; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Intervertebral Disc; Klebsiella pneumoniae; Pseudomonas aeruginosa; Radiography; Radiopharmaceuticals; Staphylococcus aureus; Staphylococcus epidermidis

Spondylodiscitis, a septic infection of the intervertebral disc Spondylodiscitis, a septic infection of the intervertebral disc and adjacent vertebrae, is an unusual infection, mainly affecting children and elderly people. It is classically associated with tuberculosis, but other germs such as Staphylococcus aureus, Streptococcus pyogenes or mitis, and some even more unususal ones (e.g. Kingella kingae), are often encountered in our countries. Non tuberculous spondylodiscitis is found in approximately 2% of pediatric bone infections. Medullar compression and bone destruction can occur, especially when diagnosis is delayed, hence the value of early diagnosis and treatment. We report the case of a non tuberculous spondylodiscitis occurring in a 22 month-old baby

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Discitis; Gait Disorders, Neurologic; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Positron-Emission Tomography; Sacrum; Teicoplanin

A 68-year-old man with septic discitis of low lumbar spine is presented. The patient suffered an acute hemorrhagic stroke due to rupture of mycotic aneurysm. Streptococcus bovis biotype I was found in blood cultures. Echocardiography showed bioprosthesis aortic endocarditis. Cardiac surgery was not performed because of normal bioprosthesis function and absence of peri-annular complications. The patient was discharged after 6 weeks of antibiotic treatment.

Topics: Aged; Anti-Bacterial Agents; Bioprosthesis; Ceftriaxone; Discitis; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Humans; Lumbar Vertebrae; Male; Streptococcal Infections; Streptococcus bovis; Treatment Outcome

In the pediatric literature, only 1 case of cervical spondylodiscitis from an ingested foreign body is reported and this was caused by a blunt radiolucent foreign body. The authors now describe a unique case of a 13-year-old teenaged boy who presented with neck pain 6 days after accidental ingestion of a sewing pin. Uncomplicated removal of this pin was followed in 36 days by the development of cervical spondylodiscitis that failed conservative management and required surgical debridement and arthrodesis. Physicians should be aware of the possibility of this complication in any patient that presents with neck pain after foreign body ingestion.

Topics: Accidents; Adolescent; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Bone Plates; Ceftriaxone; Cervical Vertebrae; Clindamycin; Combined Modality Therapy; Deglutition Disorders; Discitis; Diskectomy; Emergencies; Equipment Contamination; Follow-Up Studies; Foreign Bodies; Humans; Laryngoscopy; Larynx; Male; Neck Pain; Oxacillin; Paresthesia; Penicillanic Acid; Pharynx; Piperacillin; Piperacillin, Tazobactam Drug Combination; Radiography; Recurrence; Retropharyngeal Abscess; Spinal Fusion; Vancomycin; Wounds, Penetrating

Topics: Anti-Bacterial Agents; Bronchoscopy; Ceftriaxone; Diagnosis, Differential; Discitis; Follow-Up Studies; Humans; Liver Abscess; Lung Abscess; Male; Middle Aged; Pneumonia, Bacterial; Radiography, Thoracic; Streptococcal Infections; Streptococcus intermedius; Time Factors; Tomography, X-Ray Computed

Topics: Accidental Falls; Aged; Aged, 80 and over; Amoxicillin; Anti-Bacterial Agents; Back Pain; Bacteremia; Ceftriaxone; Cephalosporins; Diagnosis, Differential; Discitis; Drug Therapy, Combination; Escherichia coli Infections; Gentamicins; Humans; Lumbar Vertebrae; Male; Penicillins