Vertebral Osteomyelitis; Methods for Diagnosis and Means of Treatment
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Objective: Vertebral osteomyelitis is an uncommon illness; adults are mostly affected. Our objective is to evaluate the short term outcome of oral versus parenteral antimicrobials treatment for pyogenic (nontuberculous and non-brucellosis) vertebral osteomyelitis, and the best invasive diagnostic method yielding a microbiological diagnosis. Methods: The medical records were reviewed in a retrospective study for patients ≥ 18 years old from five urban hospitals within Amman-Jordan; two teaching and three primary care hospitals, during the period between August 1999 to June 2007. Due to the small numbers in the arm of antimicrobials treatment, tstudents’ test was used to assess inferences like 95% confidence interval and p-values for the difference among treatment arms. Results: Seventy-four medical records were available, inpatients records 35 from two teaching hospitals, 39 records from three primary care hospitals. The orally treated patients showed lack of difference against the parenteral therapy group at the end of 6 weeks therapy (p > 0.05). Diagnostic methods tested for microbiological diagnosis were as follows; True cut biopsy, fine needle aspiration and limited laminectomy did not differ significantly in their microbiological diagnostic ability. Our data suggested lack of difference between oral and parenteral therapy groups at the end of six weeks treatment, but a questionable tendency (95% CI; -0.11 to 0.64, p= 0.08). The diagnostic ability of the three methods did not suggest significant differences (p >0.05), except for true cut biopsy versus fine needle aspiration where it showed tendency (95% CI; - 0.20 to 0.42, p= 0.07). Conclusion: The key to successful management is the early diagnosis, and bone sampling for microbiological examination, allowing proper antimicrobial selection. A proper bone sampling method is important to evaluate, especially in the absence of surgical indication and the co-notation in some parts of the world that M. tuberculosis is the most -if not the sole- pathogen in vertebral osteomyelitis.Keywords:
Medical record
Vertebral Osteomyelitis
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Background: Sepsis in modern surgery continues to be a significant problem for healthcare practitioners across the world. The proper use of resources is a critical challenge for health services. The optimal time for administration of preoperative doses is within 60 minutes before surgical incision. Short postoperative course of antimicrobials involving a single dose or continuation for less than 24 hours is the recommendation. Objectives: To evaluate the current timing practice and duration of antibiotic prophylaxis in patients underwent appendectomy. Patients and methods: A cohort study conducted in Omdurman teaching hospital (November 2011 to August 2012). It included all consecutive patients with appendicitis managed by appendectomy. Patients were followed up for one month and wound was assessed using ASEPSIS classification for presence of wound infection. The collected data was managed statistically using SPSS computer program version 21. Results: The study included 255 patients (192 (75.3%) males, 63 (24.7%) females) with male to female ratio of 3.1:1. Their mean age was 21.6 years (range 7 to 42 years). ASA I was recorded in 98.4%. Mean operative time was 42 minutes. Only 38.04% of patients received precisely timed prophylactic antibiotics. Incidence of surgical site infection (SSI) was 12.2%. According to ASEPSIS classification infection was minor, moderate, and severe in 19 (7.45%), 10 (3.92%) and 2.0 (0.78%) respectively. SSIs were developed in one to two weeks postoperatively in 93.5% of patients. Risk factors were such as smoking, diabetes mellitus or hypertension were studied and found to be statistically not significant p > 0.05. A higher incidence and statistically significant proportion of wound infections were developed in the group of patients that received antibiotics in either intra or postoperatively, p = 0.001.Conclusion: The most common violation of protocol is poor timing of the preoperative dose and prolonged duration of the prophylaxis.
Asepsis
Surgical Site Infection
Surgical wound
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Dental extraction
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Medical record
Pelvic inflammatory disease
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Objective: To determine the presentation of abdominal tuberculosis and its outcome in terms of morbidity and mortality. Study design: Retrospective chart review Place and duration of study: This study was conducted at the Department of General Surgery, Pakistan Institute of Medical Sciences , Islamabad and included patients with abdominal tuberculosis managed between Jan 2007 to Dec 2009. Materials and Methods: All adult patients of either gender who presented with abdominal tuberculosis and were managed during the study period were included in the study. Records of the patients were retrieved and reviewed to measure parameters of age, gender , mode of presentation, evidence of co-existing tuberculosis , family history, socioeconomic status and drug history of anti tuberculous treatment . The treatment modalities were also reviewed and included the duration of hospital stay. The diagnosis of abdominal tuberculosis was confirmed by histopathology. Results: A total of 92 patients were included in the study. Out of these, 57 patients (62%) were female and 35 patients (38%) were male. The mean age was 37 ± 16.23 years. 42 patients (45.6%) presented with acute while 5 patients (5.4%) presented with subacute intestinal obstruction. 38 patients (41.3%) presented with signs of peritonitis. 7 patients (7.6%) with mass right iliac fossa. 4 patients (4.4%) were treated conservatively while rest of them 88 (95.6%) had surgery. Emergency laprotomy was performed in patients with peritonitis. Two staged procedures were performed in 57 patients (64.7%) During hospital course, 12 (13.6%) patients had post operative complications in which wound infection was most common. All patients were prescribed anti tuberculous therapy for 12 months duration. Mean hospital stay was 16 ± 14.67 days.
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Iliac fossa
Presentation (obstetrics)
Histopathology
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Antibiotic therapy is a recognised standard of care in open fractures. The purpose of this study was to look into the consistency of pattern of antibiotic prescribing practice in the management of open fractures .Eighty children presenting with open tibial fractures between 1989 and 2009 were taken into this retrospective audit. The relevant information was collected from the case records. Patients were grouped into two groups, those who were treated before and those after the guidelines. Seventy-eight patients with complete records were included in this audit. 37 patients had Gustilo and Anderson Grade I, 24 had grade II and 17 had Grade III open fractures. First dose intravenous antibiotic was given in A&E department in 55 patients. Sixty four patients had cephalosporins and 24 patients had pencillins. In 7 patients additional metronidazole was given. Only intravenous therapy was given in 29 patients and intravenous therapy followed by oral antibiotics in 49 patients. Average duration of intravenous therapy for patients treated before 1997, was 2.9 days. Whereas those treated after 1997, had average intravenous therapy for 2.8 days. There is lack of consistency in use of prophylactic antibiotics in open fractures. This audit has prompted us a reevaluation of antibiotic therapy in open fractures to find a consistent regimen
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Regimen
Antibiotic Therapy
Intravenous therapy
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The aim of this study was to assess the quality of care indicators in the management of peritonitis. A total of 124 cases with diagnosis of secondary and tertiary peritonitis were included. Detailed clinical history, examination, relevant investigations and details of operative findings were noted. The following quality indicators–surgical consultation time, waiting period for surgery, diagnostic accuracy, antibiotic utilization pattern, morbidity, mortality, length of hospital stay, and accessibility of service to patients were assessed. The mean age of patient was 37.4 years with male to female ratio of 4.4:1. More than half of the patients (51.6%) surgical consultation time was less than half an hour. Majority of patients (67.7%) were operated only after 6 hours. Duodenal ulcer perforation was the commonest etiology for peritonitis and the clinical diagnostic accuracy was 97.3%. The commonest bacteria isolated from peritoneal fluid culture was E.coli which was sensitive to Amikacin mostly. The overall morbidities were seen in 20.1% of patients and burst abdomen was the leading complication. A total of 8 patients (6.4%) died in this study and when Mannheim’s peritonitis index (MPI) score was compared, score of more than 26 was found to be a significant predictor of mortality (p<0.0001). Most of the patients after reaching the tertiary care hospital were managed satisfactorily. Though there are lots of parameters that still need to be improved.
Perforation
Etiology
Amikacin
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Many clinicians in the ENT find very difficult to diagnose the stage of infection and therapeutic options and also RPSAs lead with very limited literature available to focus the treatment option in limited resource set up. The main cutting edge of the study aims to correlate post surgical complications of RPSAs and also we know the age related incidence. A prospective and retrospective study was undertaken in the Department of ENT, BMCRI. The incumbent laboratory parameters like throat culture was done for all the suspected patients , Complete blood counts (CBC) , X-ray the results revealed that a total sixty suspected pediatric patients were were studied prospectively and retrospectively for the period of two years ,out of which males 35 and females was 25 respectively.Themean age of the patient was 8.96±1.25 years (IQR 4-14years ) median age was 10 years adiological impressions and Computed tomography (CT) scan was done at the greater accuracy. Reduced width of the air column is most common after post surgical intervention and it was found to be statistically significant (p
Keywords: Retropharyngeal abscess, Demographic profile, Surgical intervention, Prospective design.
Retropharyngeal Abscess
Throat
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One of the most difficult questions facing a hospitalist is when to transition to oral antibiotics. Osteoarticular infections continue to be one of the diagnoses that pit infectious disease (ID) , hospitalists, and surgeons against each other, with varying degrees of comfort with duration of oral versus intravenous antibiotics. A group out of Singapore has been using C-reactive proteins (CRPs) to help make the decision and have some exciting findings. 1
#### The study
This was a retrospective case series of all pediatric patients aged 6 weeks to 18 years admitted to the KK Women’s and Children’s Hospital from 2007 to 2013 with a diagnosis of osteoarticular infection. Intravenous antibiotics were used until clinical improvement was noted, and the CRP level decreased by half over a period of 4 days, at which time they switched to oral antibiotics. Patient follow-up was conducted via chart review for a period of 18 months to assess for complications.
#### The key findings
A total of 37 patients were included, 24 with osteomyelitis only, 11 with septic arthritis only, and 2 with both. Of these, 34 patients transitioned to oral antibiotics after a 50% decline in CRP over 4 days. One of these patients developed complications (2.94%). The …
Intravenous antibiotics
Oral medicine
Pediatric hospital
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Background: Bone (cortex and marrow) and joint infection are not uncommon in this health institution. The management of patients with the lesion has posed a challenge yet the institution is in top gear training the surgeons in the field of orthopaedic and trauma surgery. This study aims to lay foundation for development of the management protocol, and further research. Objective: To evaluate the management of Bone and Joint infection in children. Design: Retrospective descriptive study. Setting: Moi Teaching and Refferal Hospital, Eldoret, Kenya. Methods: The relevant data of 85 consecutive patients on aspects of demography and the management in the period 2001- 2006 were recorded into the data sheet (proforma), then analyzed and presented in statistical patterns. Results: Eighty five consecutive patients (47 males, 38 females), ratio M: F =1.24:1. Admission rated at least 14±2SD patients per year. Age: 2weeks-13 years, mean= 7.53 ±3.98SD. Major risk/predisposing factor-trauma. Duration of symptoms: 1 day-2 years, mean=16.44± 11.28SD. Commonest symptomatology included pain, swelling and loss of function more so in the joints than in bones. Of investigations- Laboratory: anaemia, bacterial isolates(33 and 14 patients respectively), while radiological/ imaging: lesions identified in patients’ radiographs, CT- scans and ultrasound scans (49, 3 and 3 respectively). Fifty six patients were diagnosed with arthritis and 39 with osteomyelitis. Treatment of 26 patients was non- operative and 59 were operated. All the patients survived. Hospital stay ranged from 2- 159 days, mean=14.16 ±9.46SD. Follow-up in clinic- 12 patients defaulted, 26 inconsistent while 47 consistent. Conclusion: Bone and joint infections were associated with significant morbidity as shown by high operative intervention and long hospital stay. Delayed presentation as noted could be responsible for the high morbidity.
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