Diagnosis Of Osteomyelitis Research Articles

Chronic Osteomyelitis in Sacral Pressure Ulcers Management Review in QA Format

Most cases of reported osteomyelitis in stage 4 pressure ulcers are almost exclusively chronic and superficial (when depth is reported). Wound cultures or bone specimen cultures lack diagnostic sensitivity or specificity. Histopathological diagnosis is necessary to make an accurate diagnosis of osteomyelitis. Surgical debridement is the mainstay of treatment for chronic osteomyelitis. Duration of antibiotics in combination with surgical management is unclear but choice should consider bone and biofilm penetration. Shorter durations of antibiotics to treat the soft tissue infection should be considered in the absence of a concrete plan for wound coverage with primary closure or rotational flap.

Subacute osteomyelitis of the tibial diaphysis associated with Brodie's abscess: A rare case report of a four-year-old child.

IntroductionSeptic osteomyelitis is a hematogenous bacterial bone infection. The acute presentation is the most common; the subacute one is less frequent. The aim of our case report is to put forward the features of this uncommon presentation and to propose a therapeutic management.Presentation of caseWe report a rare case of subacute osteomyelitis associated with Brodie's abscess of the tibial diaphysis in a four-year-old child. The chief complaint was a pain in the left tibia evolving for five weeks. The radiological findings and the unusual location of this pathology suggested a malignant bone tumor. Thanks to imaging assessment and bone biopsy the diagnosis of subacute osteomyelitis associated with Brodie's abscess was made. Therefore, the child had antibiotic therapy and plaster immobilization to avoid pathological fracture. Pain relief and radiological improvement was obtained after 3 months of antibiotic treatment. At a two-year follow-up, the X-ray was normal.DiscussionWe report an uncommon case of subacute osteomyelitis which evolved to Brodie's abscess with diaphyseal location. The mainstream treatment is surgery combined with antibiotics. However, medical treatment alone can lead to recovery without sequelae.ConclusionBecause of the atypical location and presentation of subacute osteomyelitis, the other differential diagnoses, especially malignant bone tumors have to be eliminated. In some cases, treatment may be based on antibiotics therapy alone.

6. CONTRIBUTION OF COPY NUMBER VARIANTS TO SCHIZOPHRENIA IN EAST ASIAN POPULATIONS

Septic osteomyelitis is a hematogenous bacterial bone infection. The acute presentation is the most common; the subacute one is less frequent. The aim of our case report is to put forward the features of this uncommon presentation and to propose a therapeutic management.We report a rare case of subacute osteomyelitis associated with Brodie's abscess of the tibial diaphysis in a four-year-old child. The chief complaint was a pain in the left tibia evolving for five weeks. The radiological findings and the unusual location of this pathology suggested a malignant bone tumor. Thanks to imaging assessment and bone biopsy the diagnosis of subacute osteomyelitis associated with Brodie's abscess was made. Therefore, the child had antibiotic therapy and plaster immobilization to avoid pathological fracture. Pain relief and radiological improvement was obtained after 3 months of antibiotic treatment. At a two-year follow-up, the X-ray was normal.We report an uncommon case of subacute osteomyelitis which evolved to Brodie's abscess with diaphyseal location. The mainstream treatment is surgery combined with antibiotics. However, medical treatment alone can lead to recovery without sequelae.Because of the atypical location and presentation of subacute osteomyelitis, the other differential diagnoses, especially malignant bone tumors have to be eliminated. In some cases, treatment may be based on antibiotics therapy alone.

Whole-Body MRI in Rheumatology: Major Advances and Future Perspectives.

Whole-body magnetic resonance imaging is constantly gaining more importance in rheumatology, particularly for what concerns the diagnosis, follow-up, and treatment response evaluation. Initially applied principally for the study of ankylosing spondylitis, in the last years, its use has been extended to several other rheumatic diseases. Particularly in the pediatric population, WB-MRI is rapidly becoming the gold-standard technique for the diagnosis and follow-up of both chronic recurrent multifocal osteomyelitis and juvenile spondyloarthritis. In this review, we analyze the benefits and limits of this technique as well as possible future applications.

Diffuse osteomyelitis of the fourth metacarpal bone in a horse caused by Clostridium perfringens

SummaryOsteomyelitis in adult horses, often associated with trauma or iatrogenic infection following surgery, usually presents as a focal area of infected bone. Diffuse osteomyelitis, affecting both the cortex and medulla, along the full length of a bone is encountered less frequently and treatment of such infections is not well reported in horses. The 2‐year‐old Warmblood mare in this case was diagnosed with diffuse osteomyelitis affecting the 4th metacarpal bone with concurrent unicortical fracture of the third metacarpal bone following traumatic injury. Computed tomography (CT) aided diagnosis in this case, providing critical additional detail to that obtained with radiography and ultrasound. This case highlights the value of CT in the diagnosis of diffuse osteomyelitis. This is the first reported case of diffuse osteomyelitis caused by Clostridium perfringens in horses. Successful treatment in this case consisted of surgical debridement of the associated abscess, followed by systemic and locoregional antimicrobial therapies.

Vertebral osteomyelitis in bacterial meningitis patients

ObjectiveTo analyze the clinical and laboratory characteristics of vertebral osteomyelitis in community-acquired bacterial meningitis patients. MethodsAll episodes of vertebral osteomyelitis in a cohort study of adult patients with community-acquired bacterial meningitis in the Netherlands were analyzed. Subsequently, a systematic review of published cases was performed. ResultsBetween March 2006 and August 2018, 10 of 1974 (0.5%) meningitis patients were diagnosed with vertebral osteomyelitis. The median age was 70 years (interquartile range (IQR) 54–74 years); six (60%) were male and four (40%) were female. The median time between diagnosis of bacterial meningitis and vertebral osteomyelitis was 6 days (IQR 1–13 days). The most common presenting symptoms were back or neck pain, occurring in seven patients (70%); one patient presented with neurological deficits due to cauda equina compression. Streptococcus pneumoniae was the causative pathogen in five patients and Staphylococcus aureus in three. The literature review identified 32 additional cases, showing a similar distribution by age, sex, and pathogen. Seven (18%) of 40 patients from the series presented here and those reported in the literature died. ConclusionsConcomitant vertebral osteomyelitis is rare in community-acquired bacterial meningitis patients. Persisting back pain is a clue to the diagnosis and should prompt magnetic resonance imaging of the spine, because prolonged antibiotic treatment or surgical treatment may be indicated.

Reliability and Safety of Bedside Blind Bone Biopsy Performed by a Diabetologist for the Diagnosis and Treatment of Diabetic Foot Osteomyelitis.

Bone biopsy (BB) performed by a surgeon or an interventional radiologist is recommended for suspicion of osteomyelitis underlying diabetic foot ulcer (DFU). To facilitate its practice, we developed a procedure allowing bedside blind bone biopsy (B4) by a diabetologist. We conducted a three-step observational study consisting of a feasibility and safety phase (phase 1) to assess the success and side effects of B4, a validity phase (phase 2) to compare DFU outcomes between positive (B4+) and negative (B4-) bone cultures, and a performance phase (phase 3) to compare B4 with the conventional surgical or radiological procedure basic bone biopsy (B3). Primary end points were the presence of bone tissue (phase 1) and complete DFU healing with exclusive medical treatment at 12 months (phases 2 and 3). In phase 1, 37 consecutive patients with clinical and/or radiological suspicion of DFU osteomyelitis underwent B4. Bone tissue was collected in all patients with few side effects. In phase 2, a B4+ bone culture was found in 40 of 79 (50.6%) participants. Among B4+ patients, complete wound healing after treatment was 57.5%. No statistical difference was observed with patients with B4- bone culture not treated with antibiotics (71.8%, P = 0.18). In phase 3, the proportion of patients with positive BB was lower in B4 (40 of 79, 50.6%) than in B3 (34 of 44, 77.3%, P < 0.01). However, complete healing was similar (64.6% vs. 54.6%, P = 0.28). No difference in rate of culture contamination was observed. B4 is a simple, safe, and efficient procedure for the diagnosis of DFU osteomyelitis with a similar proportion of healing to conventional BB.

Diagnosis and Management of Osteomyelitis in Children

Sponsoring Organizations: Pediatric Infectious Diseases Society, Infectious Diseases Society of AmericaBackgroundThese evidence-based clinical practice

A Review of Consecutive Cases to Identify the Rate of Underlying Osteomyelitis in Patients Undergoing Surgical Treatment of Gangrene of the Forefoot and Impact of Acute Infection on Outcome Following Amputation

Medical literature offers no clear treatment guidelines when performing amputations for gangrene of the forefoot despite a high percentage that suffer poor outcome due to infection. Gas gangrene and wet gangrene are often preceded by dry stable gangrene. This is a retrospective review of consecutive patients who underwent forefoot amputation and bone biopsy as treatment of forefoot gangrene by a single surgeon. Procedures performed included digital, ray, or transmetatarsal amputation with bone biopsy sent for both culture and histopathologic evaluation. One hundred patients (35 females, 65 males) met inclusion criteria. Mean follow-up was 9.6 months. Mean age was 63.5 years old. Forty-six out of 100 (46%) had elective amputation while 54/100 (54%) were emergent for acute infection. Vascular intervention was performed in 52/100 (52%). Seventy-eight out of 100 (78%) had histopathologic diagnosis of acute osteomyelitis while 82/100 (82%) had positive bone culture. Patients with acute infection had worse outcomes, with higher rates of more proximal amputation and delayed wound healing. We found that 79.7% of patients who underwent forefoot amputation due to gangrene had underlying osteomyelitis. We also found that those with acute infection during the time of amputation had poorer postamputation outcomes such as delayed wound healing, revision surgery, and high rates of more proximal amputation. Therefore, it may imply that earlier amputation of stable gangrene prior to becoming acutely infected may decrease the occurrence of osteomyelitis and avoid some of the preventable postamputation complications. Further studies are warranted.

Culture-negative chronic hematogenous osteomyelitis in a two months old girl: a case report

BackgroundPrevious articles have focused on the diagnosis and treatment of acute hematogenous osteomyelitis. Here, we present a case of chronic hematogenous osteomyelitis in a 2-month-old girl. The diagnostic procedure was unusual and difficult due to negative culture results.Case presentationA girl aged 2 months and 23 days had fever and swelling in her right lower leg for 7 days. On the basis of her medical history, physical, and histological examination results; and radiologic and magnetic resonance imaging findings, a diagnosis of chronic osteomyelitis was made. The patient underwent surgical treatment and was discharged successfully. The patient showed good recovery and no sequelae at the 12-month follow-up.ConclusionHematogenous osteomyelitis in babyhood is different from that at any other age. Hematogenous osteomyelitis-related bone destruction in babyhood is more serious and occurs faster. The transition from acute hematogenous osteomyelitis to chronic hematogenous osteomyelitis takes only 7 days. To the best of our knowledge, this chronic hematogenous osteomyelitis patient is the youngest ever reported.

P74. Cost impact of intravenous drug use on the treatment of spine infections

<h3>BACKGROUND CONTEXT</h3> Intravenous drug use (IVDU) is the most common cause of spinal infections in otherwise healthy young patients without medical risk factors or significant comorbidities. IVDU is also associated with significant medical and psychological morbidity and mortality, resulting in a large financial burden to the entire health care system. Psychosocial issues and noncompliance are common, plaguing and complicating the logistics of standard of care. <h3>PURPOSE</h3> The purpose of this study is to identify the cost of treating spinal infections in patients with IVDU history and compare it to the cost of treating similar infections in medical patients without IVDU history. <h3>METHODS</h3> A retrospective chart review was performed to identify all adult patients admitted in 2018 to a single tertiary referral center with a diagnosis of discitis, vertebral osteomyelitis, or spinal epidural abscess. Information on demographics, treatment, comorbidities, costs of treatment, and payment were collected for each patient. Data was compared between the group with IVDU history and the group without. <h3>RESULTS</h3> A total of 130 patients met inclusion criteria; 42 had IVDU history and 88 did not. The non-IVDU group was found to be older (age of 63.7 years vs 41.3 years, p<0.0001) with higher rates of diabetes, end stage renal disease, and cancer, and lower rates of infective endocarditis and liver disease. The average length of stay in the hospital was 28.1 days for the IVDU group, and 13.5 for the non-IVDU group (p<0.0001). Nine (21.4%) of the IVDU group were able to be discharged to rehab or long-term care facility for treatment, while 38 (43.2%) of the non-IVDU were discharged to another facility (p=0.0001). Forty (95.2%) of the IVDU group and 75 (85.2%) of the non-IVDU group had either Medicare or Medicaid as their insurance (p=0.06). Average total charge per hospitalization for the patients in the IVDU group was $141,070 and $125,283 in the non-IVDU group (p=0.41). Insurance payment per day was significantly lower in the IVDU group compared to the non-IVDU group, with the values being $1,231.47 and $3,549.61, respectively (p=0.0008). Total cost per day to the hospital was also significantly lower in the IVDU group, who had a per day cost of $3,374.16 compared to $6,788.19 in the non-IVDU group (p=0.0049). Total charges per day were lower in the IVDU group at $6,192 compared to $10,151.20 in the non-IVDU group (p=0.0009). <h3>CONCLUSIONS</h3> While those who use IV drugs do not cost the hospital as much per day as others being treated for spinal infections, the length of stay for these patients is more than double that of non-IV drug users. This is likely due to the practice in many hospitals, where active IVDU history is a contraindication to discharge with long-term intravenous access (such as peripheral intravenous central catheters). This population is also often self-pay or Medicaid, thereby often not accepted by short-term rehabilitation or long-term care facilities to finish their medical treatment. Tertiary care centers are often left to treat these patients until completion of intravenous course. This constellation of situational consequences results in a significant loss of revenue and tieing-up of resources that could otherwise be utilized on other patients. This study quantifies the significant cost burden created by IVDU-associated spine infections in one tertiary academic hospital center and offers insight on specific areas where policy and public health can help in minimizing the cost of this epidemic. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Clinical Practice Guideline by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America: 2021 Guideline on Diagnosis and Management of Acute Hematogenous Osteomyelitis in Pediatrics.

This clinical practice guideline for the diagnosis and treatment of acute hematogenous osteomyelitis (AHO) in children was developed by a multidisciplinary panel representing Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA). This guideline is intended for use by healthcare professionals who care for children with AHO, including specialists in pediatric infectious diseases, orthopedics, emergency care physicians, hospitalists, and any clinicians and healthcare providers caring for these patients. The panel's recommendations for the diagnosis and treatment of AHO are based upon evidence derived from topic-specific systematic literature reviews. Summarized below are the recommendations for the diagnosis and treatment of AHO in children. The panel followed a systematic process used in the development of other IDSA and PIDS clinical practice guidelines, which included a standardized methodology for rating the certainty of the evidence and strength of recommendation using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. A detailed description of background, methods, evidence summary and rationale that support each recommendation, and knowledge gaps can be found online in the full text.

Taking a crack at the dome: histopathology of a pachycephalosaurid (Dinosauria: Ornithischia) frontoparietal dome

Recent studies have identified numerous pathologies in the cranial domes of pachycephalosaurid dinosaurs. These studies utilized CT images of domes to identify secondary woven bone and sclerosis associated with the pathologies. These features were critical for diagnosing post-traumatic osteomyelitis, which supported the head-butting behaviour hypothesis. However, conventional CT image resolution may not be sufficient to identify secondary woven bone or sclerotic bone in fossil specimens. UALVP 8504 (cf. Foraminacephale brevis), a dome possessing putative bone lesions, was thin-sectioned and micro-CT scanned. Thin sections revealed the lesions are lytic, without any secondary woven bone or sclerosis, falsifying the diagnosis of osteomyelitis. The morphology and histology of the lesions of UALVP 8504 are not diagnostic and resemble both post-traumatic and non-traumatic lesions. However, UALVP 8504 possesses shifted vascular canals (repositioning via remodeling, which maintains anatomical position throughout ontogeny) that are decoupled from growth (), and drifting osteons (secondary osteons where resorption occurs longitudinally and transversely). These demonstrate that the dome has sustained external mechanical loading, likely resulting from an impact or multiple impacts, consistent with the head-butting hypothesis. These impacts may have damaged overlying soft tissues and formed the lesions along the surface. Therefore, we suspect that the pathologies in UALVP 8504 are post-traumatic.

Efficacy of diffusion-weighted magnetic resonance imaging in the diagnosis of osteomyelitis of the mandible

This retrospective cohort study aimed to determine the diagnostic utility of apparent diffusion coefficient (ADC) values in the quantitative evaluation of mandibular osteomyelitis. We analyzed the records of 70 patients aged 30 to 90 years, with and without osteomyelitis, who underwent magnetic resonance imaging at the Nihon University School of Dentistry between April 2017 and March 2019. The mean ADC of bone marrow of patients without osteomyelitis and those with acute and chronic osteomyelitis of the mandible were calculated. Differences in ADC overall and in pair-wise comparisons were analyzed. Correlations with patient age were also calculated. The mean ADC values in the nonosteomyelitis, acute osteomyelitis, and chronic osteomyelitis groups were 0.87 ± 0.15×10-3, 1.24 ± 0.11×10-3, and 1.07 ± 0.13×10-3 mm2/s, respectively (P < .001 for all pair-wise comparisons). Receiver operating characteristic curve analysis revealed an ADC cut-off of 0.98 for osteomyelitis. Diagnostic values for predicting osteomyelitis were ≥ .81. No correlations of osteomyelitis with age were found. The ADC was significantly higher in the osteomyelitis groups than in the nonosteomyelitis group. This suggests that ADC may be a useful parameter for quantitative evaluation of mandibular osteomyelitis.

Utility of Inflammatory Markers in Hospitalized Children With Skin Erythema.

There is overlap in the clinical presentations of superficial skin infections (eg, cellulitis) and deeper infections (eg, osteomyelitis). Inflammatory markers are frequently obtained in hospitalized patients with cellulitis. However, it is unknown whether inflammatory markers discriminate between superficial and deeper infections. We performed a retrospective review of children hospitalized with erythema on the skin and diagnoses of cellulitis, bursitis, myositis, osteomyelitis, and/or tenosynovitis. Patients were grouped into superficial infection (cellulitis and bursitis) and deeper infection (myositis, tenosynovitis, osteomyelitis). We compared C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values between the two groups and constructed receiver operating characteristic curves to determine optimal cutoff values. Among 168 children hospitalized with skin erythema, 122 patients had superficial and 46 patients had deeper infections. Mean CRP and ESR were significantly higher in patients with deeper infections (CRP: 8.3 [±9.6] mg/dL versus 2.8 [±3.5] mg/dL; P < .001; ESR: 48.3 [±28.6] mm/h versus 21.8 [±16.0] mm/h; P < .001). Neither WBC nor fever was significantly different between groups. CRP ≥2 mg/dL and ESR ≥30 mm/h were associated with deeper infections (CRP: odds ratio: 4.77; 95% confidence interval: 2.24-10.15; ESR: odds ratio: 7.93; 95% confidence interval: 3.46-17.67). When CRP and ESR were below these cutoffs, the negative predictive value was 89%. Among patients presenting with skin erythema, CRP ≥2 mg/dL and ESR ≥30 mm/hr were significantly associated with deeper infection, whereas values below these cutoffs were reassuring against deeper infection. Future study of inflammatory markers in skin and soft tissue infections may help develop tailored testing strategies.

448-P: Serum Inflammatory Markers Are Not Correlated with Detection of Osteomyelitis by 99mTC-WBC SPECT/CT Imaging in Subjects with Diabetes and Foot Infection

Osteomyelitis is a common complication in diabetic foot ulcers. Accurate and early detection of diabetic foot osteomyelitis (DFO) is key to optimizing clinical outcomes and avoiding amputation. Using bone biopsy histopathology as the gold diagnostic standard, we evaluate the sensitivity and specificity of radiolabeled white blood cell imaging combined with CT (99mTc-WBC SPECT/CT) for the evaluation of DFO. We also assess the ability of the inflammatory markers CRP and ESR to predict osteomyelitis diagnosis by 99mTc-WBC SPECT/CT imaging. Subjects with diabetes and foot ulcerations presenting to a large tertiary care facility were examined by podiatry. Of the 48 subjects who consented to participation, 44 completed imaging, labwork, and underwent biopsy. Serum CRP and ESR were collected within three days of consent. In all cases, WBC imaging studies were performed prior to biopsy. The WBC SPECT/CT scans were read by an experienced Nuclear Medicine radiologist. Pathology was performed in the hospital laboratory and interpreted by a pathologist experienced in MSK infections. SPECT/CT and pathology reads were coded as either positive or negative for osteomyelitis. Sensitivity and specificity of 99mTc-WBC SPECT/CT for DFO diagnosis was 90.9% and 73.7%, respectively. WBC imaging had a PPV of 80.0%, and 87.5% NPV (n=41). CRP and ESR serum levels were grouped according to positive or negative DFO diagnosis as determined by WBC scan. Neither CRP (p=0.9895) nor ESR levels (p=0.8382) were correlated with DFO diagnosis based on WBC imaging results. Using bone biopsy results as the reference standard, radiolabeled 99mTc-WBC SPECT/CT demonstrates sensitivity for DFO. However, CRP and ESR were not found to be predictive in the diagnostic interpretation of 99mTc-WBC SPECT/CT imaging for the diagnosis of DFO. Disclosure A. Sherwood: None. L. A. Lavery: None. O. K. Oz: n/a. K. L. Rubitschung: None. A. L. Killeen: None. P. Crisologo: None. K. Grigoropoulos: None. A. Pajouh: None. J. Kep: None. D. Wukich: Consultant; Self; Orthofix Medical Inc., Wright Medical Group, Other Relationship; Self; Arthrex, Inc. J. La fontaine: None. Funding American Diabetes Association (1-17-ICTS-056 to O.K.O.)

The role of remnant bone microbiological cultures in managing diabetic foot osteomyelitis

Aim: Effective treatment of diabetic foot osteomyelitis can reduce the risk of major amputations. Our primary aim was to compare the yield in cultures from the proximal and distal segments of bone excised intraoperatively and the impact on antibiotic choice and duration.Methods: Patients with a confirmed diagnosis of osteomyelitis on bone culture results, where both proximal and distal bone segment samples had been collected, were retrospectively reviewed. Microbiological data were examined to identify true pathogens and studied against antimicrobial choice and duration of prescribing.Results: A total of 47 forefoot amputation cases were studied. In 89% of cases, definite or likely pathogens were isolated from the deep tissues cultured. Definite pathogens (Staphylococcus aureus, Group B streptococcus, Group G streptococcus and Streptococcus anginosus) were identified in 32% of cases; in 73% of these, definite pathogens were grown in both the proximal and distal bone segments.Conclusion: Sampling of remnant bone culture can help in reducing the duration of antibiotic treatment in patients (27% of cases in our series) as it is challenging to correctly estimate intraoperatively whether clear surgical margins have been adequately achieved when resecting infected bone.

This Article Corrects: "Subacute Presentation of Central Cord Syndrome Resulting from Vertebral Osteomyelitis and Discitis: A Case Report".

Introduction: Central cord syndrome (CCS) is a clinical syndrome of motor weakness and sensory changes. While CCS is most often associated with traumatic events. There have been few documented cases being caused by abscesses resulting from osteomyelitis.Case Report: A 56-year-old male presented to a regional trauma center complaining of excruciating neck and bilateral upper extremity pain. Computed tomography of the cervical and thoracic regions revealed severe discitis and osteomyelitis of the fourth and fifth cervical (C4-C5) with near-complete destruction of the C4 vertebral body, as well as anterolisthesis of C4 on C5 causing compression of the central canal. Empiric intravenous (IV) antibiotic therapy with ampicillin/sulbactam and vancomycin was initiated, and drainage of the abscess was scheduled. After the patient refused surgery, he was planned to be transferred to a skilled nursing facility to receive a six-week course of IV vancomycin therapy. A month later, patient returned to emergency department with the same complaint due to non-compliance with antibiotic therapy.Discussion: Delayed diagnosis and treatment of osteomyelitis can result in devastating neurological sequelae, and literature supports immediate surgical debridement. Although past evidence has suggested surgical intervention in similar patients with presence of abscesses, this case may suggest that antibiotic treatment may be an alternative approach to the management of CCS due to an infectious etiology. However, the patient had been non-compliant with medication, so it is unknown whether there was definite resolution of the condition.Conclusion: In patients presenting with non-traumatic central cord syndrome, it is vital to identify risk factors for infection in a thoroughly obtained patient history, as well as to maintain a low threshold for diagnostic imaging.

Sensitive and Label-free Detection of Bacteria in Osteomyelitis through Exo III-Assisted Cascade Signal Amplification.

Rapid and sensitive pathogenic bacterial identification and isolation from complicated clinical specimens are of great importance for the early diagnosis and prevention of osteomyelitis. Herein, we proposed a novel methicillin-resistant Staphylococcus aureus (MRSA) detection strategy through two specially designed streptavidin magnetic bead-based probes, including a capture probe and a report probe. In detail, the capture probe takes the responsibility to specially bind with the surface protein of MRSA and leads to the liberation of the promoter which could subsequently initiate report probe-based signal amplification. Afterward, the hybridization of the promoter probe with the report probe could then transform the protruding 3′ terminus of template DNA in the report probe into a blunt end. With the assistance of Exo III, the template could be digested to liberate the promoter to form a recycle and to liberate the biprobe to induce the following rolling circle amplification (RCA)-based signal amplification. Through the integration of the Exo III-assisted recycle and RCA-based signal amplification, the proposed method exhibited a favorable detection performance.

Comparative 1-Year Outcomes of Invasive Staphylococcus aureus Infections Among Persons With and Without Drug Use: An Observational Cohort Study.

Persons who use drugs (PWUD) face substantial risk of Staphylococcus aureus infections. Limited data exist describing clinical and substance use characteristics of PWUD with invasive S. aureus infections or comparing treatment and mortality outcomes in PWUD vs non-PWUD. These are needed to inform optimal care for this marginalized population. We identified adults hospitalized from 2013 to 2018 at 2 medical centers in San Francisco with S. aureus bacteremia or International Classification of Diseases-coded diagnoses of endocarditis, epidural abscess, or vertebral osteomyelitis with compatible culture. In addition to demographic and clinical characteristic comparison, we constructed multivariate Cox proportional hazards models for 1-year infection-related readmission and mortality, adjusted for age, race/ethnicity, housing, comorbidities, and methicillin-resistant S. aureus (MRSA). Of 963 hospitalizations for S. aureus infections in 946 patients, 372 of 963 (39%) occurred in PWUD. Among PWUD, heroin (198/372 [53%]) and methamphetamine use (185/372 [50%]) were common. Among 214 individuals using opioids, 98 of 214 (46%) did not receive methadone or buprenorphine. PWUD had lower antibiotic completion than non-PWUD (70% vs 87%; P < .001). While drug use was not associated with increased mortality, 1-year readmission for ongoing or recurrent infection was double in PWUD vs non-PWUD (28% vs 14%; adjusted hazard ratio [aHR], 2.0 [95% confidence interval {CI}: 1.3-2.9]). MRSA was independently associated with 1-year readmission for infection (aHR, 1.5 [95% CI: 1.1-2.2]). Compared to non-PWUD, PWUD with invasive S. aureus infections had lower rates of antibiotic completion and twice the risk of infection persistence/recurrence at 1 year. Among PWUD, both opioid and stimulant use were common. Models for combined treatment of substance use disorders and infections, particularly MRSA, are needed.