Archive for January 15, 2014

Carbapenem-resistant Enterobacteriaceae: a menace to our most vulnerable patients.

Cleve Clin J Med. 2013 Apr;80(4):225-33.

Perez F, Van Duin D.


The emergence of carbapenem-resistant Enterobacteriaceae (CRE) highlights the importance of effective antibiotics to maintain the safety of our health care system. Clinicians will encounter CRE as a cause of difficult-to-treat and often fatal infections in hospitalized patients.

We review the mechanisms of carbapenem resistance, the dissemination and clinical impact of these resistant organisms, and challenges to their detection, treatment, and control.


January 15, 2014 at 8:37 am

Pyogenic spondylitis.

Int Orthop. 2012 Feb;36(2):397-404.

Cheung WY, Luk KD.


Pyogenic spondylitis is a neurological and life threatening condition. It encompasses a broad range of clinical entities, including pyogenic spondylodiscitis, septic discitis, vertebral osteomyelitis, and epidural abscess. The incidence though low appears to be on the rise. The diagnosis is based on clinical, radiological, blood and tissue cultures and histopathological findings. Most of the cases can be treated non-operatively. Surgical treatment is required in 10-20% of patients. Anterior decompression, debridement and fusion are generally recommended and instrumentation is acceptable after good surgical debridement with postoperative antibiotic cover.


January 15, 2014 at 8:32 am

Treatment of spondylodiscitis.

Int Orthop. 2012 Feb;36(2):405-11.

Zarghooni K, Röllinghoff M, Sobottke R, Eysel P.



Pyogenic infections of the spine are relatively rare with an incidence between 1:100,000 and 1:250,000 per year, but the incidence is increasing due to increases in average life-expectancy, risk factors, and medical comorbidities. The mean time in hospital varies from 30 to 57 days and the hospital mortality is reported to be 2-17%. This article presents the relevant literature and our experience of conservative and surgical treatment of pyogenic spondylodiscitis.


We have performed a review of the relevant literature and report the results of our own research in the diagnosis and treatment of pyogenic spondylodiscitis. We present a sequential algorithm for identification of the pathogen with blood cultures, CT-guided biopsies and intraoperative tissue samples. Basic treatment principles and indications for surgery and our surgical strategies are discussed.


Recent efforts have been directed toward early mobilisation of patients using primary stable surgical techniques that lead to a further reduction of the mortality. Currently our hospital mortality in patients with spondylodiscitis is around 2%. With modern surgical and antibiotic treatment, a relapse of spondylodiscitis is unlikely to occur. In literature the relapse rate of 0-7% has been recorded. Overall the quality of life seems to be more favourable in patients following surgical treatment of spondylodiscitis.


With close clinical and radiological monitoring of patients with spondylodiscitis, conservative and surgical therapies have become more successful. When indicated, surgical stabilisation of the infected segments is mandatory for control of the disease and immediate mobilisation of the patients.


January 15, 2014 at 8:31 am

Spondylodiscitis with primary abscess in a neonate.

Indian Pediatr. 2012 Aug;49(8):681.


Mondal R, Sarkar S.

Primary psoas abscess is rare in neonates. Spondylodiscitis, although reported in older children, is extremely uncommon in newborns. Co-existence of these two conditions is even rarer and reported in adult patients.

We report a case of neonatal spondylodiscitis with primary psoas abscess following infection with methicillin resistant staphylococcus aureus (MRSA), hitherto unreported in this age group …


January 15, 2014 at 8:29 am

Panspinal epidural and psoas abscess with secondary cervical disc space infection.

Ulster Med J. 2013 Jan;82(1):23-5.

Shoakazemi A, Amit A, Nooralam N, Abouharb A, Gormley M, McKinstry S.

Psoas and epidural spinal abscesses have been described as relatively rare conditions. The incidence of epidural spinal abscess, however, has doubled in the recent two decades, reaching 1 in 10000 hospital admissions.

Early diagnosis and management of these two pathologies, especially when presenting with insidious and vague symptoms, require a high degree of suspicion. In this case, unusual evolving cervical disc space infection was also noted …


January 15, 2014 at 8:27 am


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