Hematogenous Infection Research Articles

Clinical application of extracorporeal membrane oxygenation in children with refractory cardiopulmonary failure

This study aimed to discribe the experience in supporting children with refractory cardiopulmonary failure with extracorporeal membrane oxygenation (ECMO). We retrospectively reviewed 12 children with refractory cardiopulmonary failure supported with ECMO from February 2009 to August 2015 in the Pediatric Intensive Care Unit (PICU), Children's Hospital, Zhejiang University School of Medicine. Seven of the 12 patients were weaned successfully from ECMO and dischaged from the hospital, with a survival rate of 58.3% (7/12). Among them, five patients had acute fulminant myocarditis (AFM). Complications during ECMO included hemorrhage, hemolysis, thrombosis, acute kidney injury, and secondary hematogenous infection. During 1-24 month follow-up, the seven surviving patients recovered with normal cardiopulmonary function. ECMO is useful for supporting children with refractory cardiopulmonary failure, especially for treatment of AFM.

Mesh cage for treatment of hematogenous spondylitis and spondylodiskitis. How safe and successful is its use in acute and chronic complicated cases? A systematic review of literature over a decade.

Surgical treatment of hematogenous pyogenic spondylitis and spondylodiskitis includes anterior debridement, stabilization, and fusion. Titanium mesh cage (TMC) has been advocated to immediately correct deformity and eradicate infection with low recurrence rates. There are no comprehensive reviews on TMC. To evaluate recorded information regarding surgical outcome with the use of TMC for treating patients with pyogenic spinal infection. Comprehensive review. The terms "titanium cage", "spine", "infection" were searched. A total of 486 peer-reviewed papers published from 2002 to 2012 were obtained from PubMed search. Fifteen Level IV articles with 363 patients were enrolled for consideration. Finally, 192 (53%) patients who received TMC were eligible and included in this review. Age, comorbidities, indications for surgery, abscess formation, time lapsed between symptoms initiation and surgery, microbiology, radiological spine restoration, neurological outcome, and complications following surgery are evaluated. The average age at the index surgery was 57years, range 15-85years. The reported time lapsed from symptoms presentation to diagnosis varied significantly from 1week to 2years. On admission, there reported paravertebral and/or epidural abscess in 48% and neurological impairment in 51% of the patients. One hundred and seventy-seven comorbidities were recorded in 192 patients. Bone biopsy and culture revealed gram (+) bacteria in 71%, gram (-) in 24%, and multiple bacteria in 1%, while it was negative in 3.1% of the patients. TMC was most commonly (49%) implanted in the lumbar spine. The follow-up observation following surgery averaged 26months, range 10-116months. Most of the studies reported decrease in segmental kyphosis and neurological improvement in incomplete lesions postoperatively. TMC was primarily revised for early dislodgment or cage misplacement in 3.2% of the patients. Infection recurrence was recorded in two patients (1.3%), but revision surgery needed in one (0.65%) patient. Mortality was reported in 5.8% of the patients. TMC offers an advantageous and safe technique for spinal debridement and fusion for hematogenous spinal infection. TMC safeguarded medium-term spinal stability with low infection recurrence rates, which were independent form causative pathogen, age, and comorbidities.

Bilateral periprosthetic joint infection with Ureaplasma urealyticum in an immunocompromised patient

This case study discusses how we diagnosed and treated a patient with a late haematogenous bilateral periprosthetic joint infection (PJI) after total knee arthroplasties caused by Ureaplasma urealyticum. This has never been reported before. We will discuss how we used a PET-CT, synovial fluid cell count, and synovial fluid analysis by 16S rRNA gene sequencing to diagnose this PJI. We will also discuss how we treated this patient to obtain full recovery.

Imaging of Osteomyelitis of the Extremities

Introduction Osteomyelitis is defined as inflammation of bone, which is typically infectious in etiology. Bacteria can seed bone directly from an adjacent ulcer, through direct inoculation by penetrating trauma, or by hematogenous spread of infection from another source. Direct spread usually infects bone with multiple organisms. Staphylococcus aureus is most commonly isolated from hematogenous infections of bone. The infecting agent triggers an inflammatory response consisting of bony hyperemia, edema, and neutrophilic infiltration. The hyperemia causes bone demineralization, seen as a subtle lucency and loss of the cortical contour on radiographs. The neutrophilic infiltrate destroys bony trabeculae, causing osteolysis and replacing the normal fatty marrow to produce the imaging appearance of acute osteomyelitis. If left untreated, the infection progresses and may lead to necrotic bone (sequestrum). This bone becomes a sanctuary for bacteria, from which these organisms continue to infect the adjacent tissues. The adjoining bone responds to the infection by laying down new reactive bone around the infected area, producing a sclerotic appearance (involucrum). It then seeks to expel the infection through a sinus tract (cloaca) that extends through the cortex to the soft tissues or the skin. At this point, the infection could be termed “chronic.”

Antimicrobial and immunomodulatory effects of tedizolid against methicillin-resistant Staphylococcus aureus in a murine model of hematogenous pulmonary infection

Tedizolid (TZD) is a second-generation oxazolidinone and demonstrates potent in-vitro activity against multidrug-resistant Gram-positive bacteria. Phase III studies in patients with acute bacterial skin and skin structure infections (ABSSSI) have demonstrated the non-inferiority of TZD to linezolid (LZD). However, there are only a few studies that show the effect of TZD in pulmonary infections. In this study, we investigated the effect of TZD in a murine model of hematogenous pulmonary infection caused by methicillin-resistant Staphylococcus aureus (MRSA). The mice were treated either twice daily with saline (control), 25mg/kg of vancomycin (low-VAN), 110mg/kg of vancomycin (high-VAN), 120mg/kg of LZD or once daily with 20mg/kg of TZD. As compared to the control, the low- and high-VAN treatment groups, LZD and TZD significantly improved the survival rate, reduced the bacterial count in the lungs. Furthermore, TZD decreased the area of central bacterial colony zone (CBCZ) at 36h post-inoculation, compared with the control. In addition, we investigated the immunomodulatory effect of TZD by evaluating the plasma concentrations of the inflammatory cytokines. Although there were no significant differences in the bacterial count in the lungs amongst the drugs at 26h post-inoculation, TZD and LZD significantly improved the plasma concentrations of TNF-alpha, IL-6 and MIP-2, in comparison with the control. In this study, both TZD and LZD demonstrated antimicrobial and immunomodulatory efficacy in a murine model of hematogenous pulmonary infection caused by MRSA.

Experimental phage therapy against haematogenous multi-drug resistant Staphylococcus aureus pneumonia in mice.

BackgroundCommunity-acquired haematogenous Staphylococcus aureus pneumonia is a rare infection, though it can be acquired nosocomially. Currently, antibiotics used against S. aureus pneumonia have shown reduced efficacy. Thus, there is need for an alternative therapy against multidrug-resistant S. aureus (MDRSA) strains in the community.ObjectiveWe sought to determine the efficacy of environmentally-obtained S. aureus lytic phage against haematogenous MDRSA pneumonia in mice.MethodsPhages and MDRSA were isolated from sewage samples collected within Nairobi County, Kenya. Isolated S. aureus bacteria were screened for resistance against ceftazidime, oxacillin, vancomycin, netilmicin, gentamicin, erythromycin, trimethroprim-sulfamethoxazole and cefuroxime. Thirty BALB/c mice aged six to eight weeks were randomly assigned into three groups: the MDRSA-infection group (n = 20), the phage-infection group (n = 5) and the non-infection group (n = 5). Mice were infected with either MDRSA or phage (108 CFU/mL) and treated after 72 hours with a single dose of clindamycin (8 mg/kg/bwt) or 108 PFU/mL of phage or a combination therapy (clindamycin and phage). The efficacy of phage, clindamycin or clindamycin with phage combination was determined using resolution of lung pathology and bacterial load in lung homogenates.ResultsThe viable MDRSA count was 0.5 ± 0.2 log10 CFU/gm in the phage-treated group, 4.4 ± 0.2 log10 CFU/gm in the clindamycin-treated group and 4.0 ± 0.2 log10 CFU/gm in the combination-treated group. The efficacy of phage therapy was significantly different from other therapeutic modes (p = 0 < 0.0001). Histology showed that the mice treated with phage did not develop pneumonia.ConclusionPhage therapy is effective against haematogenous MDRSA infection. Thus, it can be explored as an alternative treatment method.

Implant retention after acute and hematogenous periprosthetic hip and knee infections: Whom, when and how?

Periprosthetic joint infections (PJI) of the hip and the knee are grossly classified as early post-operative, acute hematogenous and late chronic infections. Whereas two-stage exchange arthroplasty is the standard of care in North America for treating chronic infections, irrigation and debridement (I and D) with retention of implants has been used in an attempt to treat the other two types of PJIs. The rationale of this approach is that a PJI may be eradicated without the need of explanting the prostheses, as long as it has not transitioned into a chronic state. With the present paper, we review current evidence regarding the role of I and D with implant retention for treating PJIs of the hip and the knee. While a very wide range of success rates is reported in different studies, a short period of time between initiation of symptoms and intervention seems to play a prominent role with regards to a successful outcome. Moreover, pathogens of higher virulence and resistance to antibiotics are associated with a poorer result. Specific comorbidities have been also correlated with a less favorable outcome. Finally, one should proceed with serial I and Ds only under the condition that a predefined, aggressive protocol is applied. In conclusion, when treating a PJI of the hip or the knee, all the above factors should be considered in order to decide whether the patient is likely to benefit from this approach.

Management of periprosthetic infections of the knee

Endoprosthetic replacement is one of the most successful operations in current medicine. As the implantation of knee prostheses increases, the number of periprosthetic infections is also rising. In case of painful or early loosening of the prosthesis an infection should be excluded by joint aspiration. Retention of the prosthesis with change of mobile parts is possible only in acute infections (< 4 weeks after surgery or duration of symptoms of <3 weeks in the case of hematogenous infection), if the prosthesis is stable, the soft tissue is intact, and no difficult-to-treat pathogens were found. In other cases a one- or two-stage prosthesis exchange should be performed. In a two-stage exchange, a short interval of 2-3 weeks is possible, if biofilm-active treatment is available. Rifampin should be used targeted (after isolation of the pathogen) and only in combination with another efficient antibiotic. In this article the current management concepts of periprosthetic infection of the knee are discussed.

Acute infection in total knee arthroplasty (TKA): Is early open débridement with polyethylene liner exchange (ODPLE) really effective?

Background: Open debridement with polyethylene liner exchange (ODPLE) is an attractive strategy for the treatment of a total knee arthroplasty (TKA) with acute infection. Purpose: The purpose of this article is to review the literature on acute infection after TKA with the aim of answering the following four questions: 1) Is ODPLE really effective?; 2) What is the success rate of ODPLE?; 3) Which factors can predict control of TKA acute infection after early ODPLE?; 4) Is the success rate of two-stage revision for infection diminished after a failed early ODPLE? M ethods: The search engine was MedLine. The keywords used were: acute TKA infection. Fifty-three articles were found until 20 October 2015. Of those, only thirteen were selected and reviewed because they were strictly focused on the topic and the question of this article. Results: Although the level of evidence of published papers is low, the mean success rate in postoperative acute infections ranged between 35% and 95%, and between 50% and 85% 70% in acute hematogenous infections. The only factor that can predict control of infection after ODPLE is the type of infected organism (Staphylococcus aureus 7% success rate, Staphylococcus epidermidis and Streptococcus species 47% success rate). The success rate of two-stage revision is diminished after a failed ODPLE (66% success rate). Conclusions: ODPLE should be considered as a viable treatment option for acute prosthetic joint infection following TKA. The promptness of ODPLE is of paramount importance for success of the procedure. In Staphylococcus aureus infections the mean success rate is 7%, while in Streptococcal or Staphylococcus epidermidis species the mean success rate is 47%. The success rate of two-stage revision for infection is diminished after a failed ODPLE (66% mean success rate). It seems that acute infections after TKA in the presence of Staphylococcus aureus must be treated by a two-stage revision arthroplasty.

Clinical Presentation, Risk Factors, and Outcomes of Hematogenous Prosthetic Joint Infection in Patients with Staphylococcus aureus Bacteremia

BackgroundStaphylococcus aureus bacteremia is a life-threatening condition that may lead to metastatic infection, including prosthetic joint infection. MethodsTo assess clinical factors associated with hematogenous prosthetic joint infection, we retrospectively reviewed all patients with a joint arthroplasty in place at the time of a first episode of S. aureus bacteremia over a 5-year period at our institution. Patients with postsurgical prosthetic joint infection without hematogenous prosthetic joint infection were excluded. ResultsThere were 85 patients (143 arthroplasties) with either no prosthetic joint infection (n = 50; 58.8%) or hematogenous prosthetic joint infection in at least one arthroplasty (n = 35; 41.2%). The odds of hematogenous prosthetic joint infection was significantly increased among patients with community-acquired S. aureus bacteremia (odds ratio [OR] 18.07; 95% confidence interval [CI] 2.64-infinity; P = .001), as compared with nosocomial S. aureus bacteremia, in which there were no patients with hematogenous prosthetic joint infection. After adjusting for S. aureus bacteremia classification, the presence of ≥3 joint arthroplasties in place was associated with a nearly ninefold increased odds of hematogenous prosthetic joint infection as compared with those with 1-2 joint arthroplasties in place (OR 8.55; 95% CI 1.44-95.71; P = .012). All but one joint with prosthetic joint infection demonstrated at least one clinical feature suggestive of infection. There were 4 additional S. aureus prosthetic joint infections diagnosed during a median of 3.4 years of follow-up post hospitalization for S. aureus bacteremia. ConclusionProsthetic joint infection is frequent in patients with existing arthroplasties and concomitant S. aureus bacteremia, particularly with community-acquired S. aureus bacteremia and multiple prostheses. In contrast, occult S. aureus prosthetic joint infection without clinical features suggestive of prosthetic joint infection at the time of S. aureus bacteremia is rare.

Development of a hematogenous implant-related infection in a rat model.

BackgroundImplant-related osteomyelitis is a major complication that requires immediate treatment, often involving removal of the implant, prolonging patient recovery and inflating expenses. Current research involving interventions to diminish the prevalence of such measures include investigating prophylactic and therapeutic remedies. A proper and accurate animal model is needed to thoroughly investigate such treatments. The scope of this project was to develop an animal model in which a consistent and measurable infection can be formed on an orthopedic implant when bacteria is introduced via a hematogenous source.MethodsTitanium Kirschner-wires were implanted into the intramedullary canals of both femurs. Staphylococcus aureus, ranging from104 to 109 colony forming units, was injected into a tail vessel. After a designated time (3, 7, 14, or 42 days) the femurs were harvested and bacterial numbers determined for both the femur and the implanted K-wire. In addition, histology and micro-computed tomography were used as subjective tools to further characterize the infection.ResultsConsistent infection, that is infection of ≥75 % of the femurs, wasn’t achieved until 107 CFU S. aureus was injected. At 107 CFU, the femurs contained 4.6x106 CFU/g bone tissue at day 3 and 4.8×108 CFU/g bone tissue by day 14. The wire showed comparable contamination with 4.8×104 CFU/mm2 at day 3 and 3.7×105/mm2 by day 14. After 42 days, the bacteria number decreased but was still occupying at 1.9×105 CFU/g bone tissue. There were morphological changes to the bone as well. At day 42, there were signs of osteonecrosis and active bone formation when compared to control animals that received a K-wire but were inoculated with saline.ConclusionsA model for hematogenous osteomyelitis, a common complication associated with implants, has been introduced. A reproducible, preclinical model is essential to evaluate future methods used to mitigate blood-borne bacteria hardware and bone infections.

Nonredundant Roles of Interleukin-17A (IL-17A) and IL-22 in Murine Host Defense against Cutaneous and Hematogenous Infection Due to Methicillin-Resistant Staphylococcus aureus.

Staphylococcus aureus is the leading cause of skin and skin structure infections (SSSI) in humans. Moreover, the high frequency of recurring SSSI due to S. aureus, particularly methicillin-resistant S. aureus (MRSA) strains, suggests that infection induces suboptimal anamnestic defenses. The present study addresses the hypothesis that interleukin-17A (IL-17A) and IL-22 play distinct roles in immunity to cutaneous and invasive MRSA infection in a mouse model of SSSI. Mice were treated with specific neutralizing antibodies against IL-17A and/or IL-22 and infected with MRSA, after which the severity of infection and host immune response were determined. Neutralization of either IL-17A or IL-22 reduced T cell and neutrophil infiltration and host defense peptide elaboration in lesions. These events corresponded with increased abscess severity, MRSA viability, and CFU density in skin. Interestingly, combined inhibition of IL-17A and IL-22 did not worsen abscesses but did increase gamma interferon (IFN-γ) expression at these sites. The inhibition of IL-22 led to a reduction in IL-17A expression, but not vice versa. These results suggest that the expression of IL-17A is at least partially dependent on IL-22 in this model. Inhibition of IL-17A but not IL-22 led to hematogenous dissemination to kidneys, which correlated with decreased T cell infiltration in renal tissue. Collectively, these findings indicate that IL-17A and IL-22 have complementary but nonredundant roles in host defense against cutaneous versus hematogenous infection. These insights may support targeted immune enhancement or other novel approaches to address the challenge of MRSA infection.

Report of a Moraxella catarrhalis prosthetic joint infection in an immunocompetent woman and review of the literature of haematogenous infection due to throat flora bacteria

Introduction: Moraxella catarrhalis is an exclusively human commensal and mucosal pathogen. For years, this bacterium has been known to cause upper and lower respiratory tract infections, the latter of which most often occur in patients with chronic obstructive pulmonary disease. However, M. catarrhalis has also been described in various unusual localizations. Case presentation: We describe the first case of a knee prosthetic infection due to M. catarrhalis. A 75-year-old immunocompetent woman developed a knee infection 5 months after a total knee arthroplasty. The origin of the infection was probably due to a bronchitis episode with haematogenous spread leading to an acute prosthetic infection. Conclusion: M. catarrhalis should be included in the list of potential pathogens from the throat flora such as Streptococcus pneumoniae and Haemophilus influenzae. A review of the literature revealed the same clinical presentation, surgical strategy and outcome.

Risk factors for metastatic osteoarticular infections after a long follow-up of patients with Staphylococcus aureus bacteraemia

We aimed to identify risk factors associated with the development of haematogenous metastatic osteoarticular infection (MOI) after an episode of Staphylococcus aureus bacteraemia (SAB). We followed 198 patients with SAB during a median of 68.9 months. Nine (4.54%) developed an MOI (median: 6.77 months) after SAB. Factors associated with MOI were the presence of joint prosthesis (hazard ratio 17.56; 95% CI 4.48–68.85) and osteoporosis (hazard ratio 8.46; 95% CI 1.9–37.57). MOI is a common complication after SAB and is related to high morbidity and mortality. Patients with previous osteoarticular disease are at the greatest risk of developing this complication.

Predictors of treatment outcome in prosthetic joint infections treated with prosthesis retention.

The reported success rates of debridement, antibiotics, and implant retention (DAIR) for prosthetic joint infections (PJIs) vary widely. Several risk factors have been described for treatment failure, but they vary between studies. The purpose of this study was to evaluate the predictors of DAIR failure in PJI treatment and to assess the efficacy of rifampin combined with ciprofloxacin versus rifampin combined with other antibiotics in staphylococcal PJIs. Patients with PJI that underwent DAIR for the first time between February 2001 and August 2009 were identified retrospectively in the hospital's patient databases. A total of 113 PJI cases with early postoperative or acute haematogenous PJI were followed for up to two years from the start of treatment. In univariate analysis, variables significantly associated with treatment failure were acute haematogenous infections (p = 0.022), leucocyte count at admission > 10 × 10(9)/l (p < 0.01), pain in the joint (p < 0.01), and ineffective empirical antibiotics (p < 0.01). In a multivariate Cox model, leucocyte count > 10 × 10(9)/l and ineffective empirical antibiotics were significant risk factors for failure. Compared to rifampin-ciprofloxacin, the hazard ratio (HR) for treatment failure was significantly increased in the rifampin-other antibiotics group (HR 6.0, 95% CI 1.5-28.8, p = 0.014) and the group treated without rifampin (HR 14.4, 95% CI 3.1-66.9, p < 0.01). Rifampin-ciprofloxacin combination therapy was significantly more effective than rifampin combined with other antibiotics. Effective empirical antibiotics are essential for successful PJI treatment.

Evaluation of The Ratio of Positivity of HBs-Ag, Anti-HCV And AntiHIV in Patients Admitted to Surgery

Aim: Contact with bloodborne pathogens constitutes a critically serious occupational risk for health care professionals. Among them, the most important and the most contagious pathogens are hepatitis B (HBV), hepatitis C (HCV) and human immune deficiency viruses This study has been realized with the intention to determine seroprevalences of HBV, HCV and HIV during preoperative period in our patients so as to increase awareness of the health care professionals about risks of haematogenous infections in their daily working environments in addition to emphasizing the importance of protective measures. Material and Methods: Hepatitis B surface antigen (HBsAg), anti-HCV and anti-HIV test results and demographic data of the patients who were operated in the Department of General Surgery of Bolu Abant Izzet Baysal University between January 2012 and December 2014 were retrospectively reviewed. Statistical analysis was performed with the chisquare test. Results: Data of a total of 659 study patients who had been operated in the Clinics of General Surgery could be accessed. The study population consisted of 659 patients (men, n=330; 50.07 %; women, n=329; 49.93%). HBsAg positivity was detected in 7 (2.1%) patients. Three (0.9%) male patients with anti-HCV positivity were detected. One patients were positive for anti-HIV Conclusion: In conclusion, health care professionals in duty are under a higher risk of contracting HBV, HCV and HIV infections. To minimize occupational infection training of the health care personnel and vaccination against HBV, HCV and HIV infections carry utmost importance.

Treatment of 50 Deep Infections After Total Knee Arthroplasty.

The prevalence of infections caused by methicillin-resistant organisms has increased, causing difficulty in the treatment of prosthetic joint infection. A multicenter study was performed to review 50 patients with deep infections with or without a resistant organism, such as methicillin-resistant Staphylococcus aureus, at the site of total knee arthroplasty. A group of 13 patients with early deep infections and 4 patients with acute hematogenous infections underwent treatment with debridement, antibiotic therapy, and retention of the prosthesis with revision of the polyethylene insert. Thirty-three patients with late chronic infections were treated with challenging prosthesis retention for prostheses that had not loosened or 2-stage exchange arthroplasty for prostheses that had loosened. Mean duration of follow-up was 4.7±1.8 years. No significant differences in resultant functional knees and mean number of operations were observed between 7 patients with resistant early deep infections and 6 patients with nonresistant early deep infections. However, 24 patients with nonresistant chronic infections showed significant improvement in resultant functional knees (24 of 24; 100%) and fewer mean operations (2.8 times) compared with 9 patients with resistant chronic infections (1 of 9, 11%, and 4.3 times, respectively). The remaining 8 patients with resistant chronic infections (89%) had arthrodesis (3 patients) or underwent above-the-knee amputation (1 patient) or spacer arthroplasty (4 patients). Although patients with resistant early postoperative deep infections showed good results that were similar to those in patients with nonresistant early infections, those with resistant late chronic infections had a significantly inferior success rate compared with those who had nonresistant late chronic infections.

La fiebre de Chikungunya en el período neonatal

Chikungunya Fever is a tropical disease unattended in many countries due to its low mortality rate. The disease is caused by the chikungunya virus (VCHIK), which is a virus that belongs to the Alphavirus genus of the Togaviridae, the family of a number o viruses that are mostly transmitted by arthropods. Aedes aegypti and Aedes albopictus are the vectors responsible for human transmission by the bite of infected mosquitoes. VCHIK disease usually shows as a self-limited arthritis, except for immunocompromised patients and newborns, in such cases it can be a serious disease. Maternal-fetus transmission can be during pregnancy in uterus (congenital), at the time of delivery (perinatal) or through lactation (postnatal). Maternal infection spreads to the embryo and fetus by ascended infection from the vagina and cervix to amniotic fluid and blood due to viremia, parasitemia or bacteremia. Fetal hematogenous infection is common during maternal viremia periods when there is a VCHIK infection. Mother to child perinatal VCHIK infection is an unusual event that only occurs during massive outburst infections, when the risk of infection in pregnant women close to delivery is important. In this type of patients, 50 % of neonates develop infection; illness clinical signs include mainly prostration and encephalopathy.

Changing trends in the epidemiology of vertebral osteomyelitis in Marseille, France.

The incidence and significant morbidity of vertebral osteomyelitis are increasing despite the progress of diagnosis competences. Among the 50 cases of vertebral osteomyelitis managed in our centers over the past 5 years, 84% of the cases were in men. The mean age was 55 years. Sixty-two percent of patients had comorbidities and risk factors: diabetes mellitus (24%), malignancy (16%), intravenous drug use (10%) and alcoholism (4%). A source of infection was identified in 66% of cases, including postvertebral surgery infection (18%) and hematogenous infection (48%). The mean time to diagnosis was 36 days. Back pain were occurred in 90% of cases, fever (70%), neurologic deficits (40%), epidural abscesses (32%), completed vertebral bone destruction (26%) and psoas abscess (12%). A single organism was isolated in 92% of cases. Gram-positive bacteria were identified in 76% of cases, while Gram-negative bacilli (GNB) were found in 18% of cases. The presence of GNB was significantly associated with malignancy (p 0.041). The mean duration of antibiotic therapy was 123 days. Surgical treatment was performed in 41 cases: spinal stabilization (26%), drainage of abscesses (32%) and relief of compression (40%). Residual pain was found in 24% of cases, and neurologic sequelae in 22%. Cervical or thoracic localization was a risk factor for neurologic compromise (p 0.042). The epidemiology of vertebral osteomyelitis has changed; an increase in malignancy that was significantly associated with vertebral osteomyelitis due to GNB has been observed. Our study shows that the rate of neurologic complications remains high despite improved diagnostic capabilities and optimal treatment.

Effects of blood glucose control on glucose variability and clinical outcomes in patients with severe acute pancreatitis in intensive care unit

To explore the effects of blood glucose control on glucose variability and clinical outcomes in patients with severe acute pancreatitis in intensive care unit (ICU). A total of 72 ICU patients with severe acute pancreatitis were recruited and divided randomly into observation and control groups (n = 36 each). Both groups were treated conventionally. And the observation group achieved stable blood glucose at 6.1-8.3 mmol/L with intensive glucose control. The length of ICU and hospital stays, ICU mortality rate, transit operative rate, concurrent infection rate, admission blood glucose, glycosylated hemoglobin, mean insulin dose, mean blood glucose, blood glucose value standard deviation (GLUSD), glycemic liability index (GLUGLI) and mean amplitude of glycemic excursion (GLUMAGE) of two groups were compared. At the same time, the relationship between blood glucose variability, ICU mortality rate and its predictive value were analyzed by correlation analysis and receiver operating characteristic curve (ROC). The lengths of ICU and hospital stays of observation group were all significantly less than those of the control group [(11.7 ± 9.9) vs (15.9 ± 8.02) days, (21.8 ± 10.8) vs (28.2 ± 12.7) days, P < 0.05]. In observation group, the rates of pulmonary infection (27.78%) and hematogenous infection (5.56%) were all significantly lower than those of control group (72.22%, 38.89%, P < 0.05). The values of mean blood glucose value and GLUSD of observation group were significantly lower than those of control group [(7.4 ± 1.1) vs (9.6 ± 1.2), (1.8 ± 1.0) vs (2.5 ± 1.3) mmol/L]. The differences were statistically significant (P < 0.05). While the dose of insulin [(70.2 ± 47.6) vs (34.4 ± 38.6) U/d] was significantly higher than that of control group (P < 0.05). Bivariate correlation analysis showed that ICU mortality rate was positively correlated with GLUGLI (r = 0.368, P < 0.05). ROC curve analysis showed that, AUC of GLUGLI was 0.748 and 95% CI 0.551-0.965 (P < 0.05). Intensive glucose control in patients with severe acute pancreatitis helps reduce the blood sugar fluctuations, lower the risks of infectious complications and promote the patient rehabilitation. And GLUGLI is positively correlated with ICU mortality rate. It has good predictive values.