Spondylodiscitis with Epidural Abscess Caused by Klebsiella pneumoniae (original) (raw)
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Klebsiella pneumoniae Spinal Epidural Abscess treated conservatively: case report and review
Acta reumatológica portuguesa
Spinal infections are rare but potentially life-threatening disorders. A high level of clinical suspicion is necessary for rapid diagnosis and treatment initiation. The treatment combines both antibiotics and surgical intervention in the vast majority of cases. The authors report the case of a 84-year old female patient with a three week history of persistent lumbar back pain radiating to both thighs following a lower respiratory tract infection. She had lumbar spine tenderness but no neurological compromise. Her inflammatory markers were elevated and lumbar spine magnetic resonance imaging revealed L4-L5 spondylodiscitis with spinal epidural abscess. Blood cultures isolated Klebsiella pneumoniae and, since she was neurologically stable, conservative treatment with two-week intravenous gentamicin and eight-week intravenous ceftriaxone was initiated with positive inpatient and outpatient evolution.
Klebsiella pneumoniae Spinal Epidural Abscess treated conservatively
Acta Reumatologica Portuguesa, 2012
Spinal infections are rare but potentially life-threatening disorders. A high level of clinical suspicion is necessary for rapid diagnosis and treatment initiation. The treatment combines both antibiotics and surgical intervention in the vast majority of cases. The authors report the case of a 84-year old female patient with a three week history of persistent lumbar back pain radiating to both thighs following a lower respiratory tract infection. She had lumbar spine tenderness but no neurological compromise. Her inflammatory markers were elevated and lumbar spine magnetic resonance imaging revealed L4-L5 spondylodiscitis with spinal epidural abscess. Blood cultures isolated Klebsiella pneumoniae and, since she was neurologically stable, conservative treatment with two-week intravenous gentamicin and eight-week intravenous ceftriaxone was initiated with positive inpatient and outpatient evolution.
International Journal of Spine Surgery, 2018
Background: The study aimed to assess the effectiveness of antibiotic treatment for spondylodiscitis, its failure rates, and the need for surgical intervention. Methods: This is a retrospective study of patients who presented with spontaneous deep spinal infections and spondylodiscitis between 2011 and 2013. Clinical, bacteriologic, and radiographic data during hospitalization were analyzed. Results: A total of 16 patients presented with deep spinal infections during the study period; 15 of them presented with spontaneous pyogenic spondylodiscitis, and 1 presented with epidural abscess. Median age was 68 years (range, 50-80 years), and 6 (38%) were healthy young laborers. None of the patients were immunocompromised. On admission all patients presented with pain, there was fever in 3 patients (19%), and there was elevated blood C-reactive protein, white blood cell count and erythrocyte sedimentation rate, with a mean of 147 6 83.1 mg/L, 11.65 6 5.6 3 10 3 /lL, 93.6 6 35.1 mm/h, respectively. A total of 15 patients (94%) developed infections that were refractory to appropriate culturespecific intravenous antibiotic treatment (mean, 10.2 days); 8 patients (50%) deteriorated neurologically and required wide surgical decompression. Complications included widespread epidural free gas in 2 patients (12%), multiple bilateral psoas abscesses in 2 patients (12%), kyphotic segmental instability in 4 patients (25%), and inferior vena cava septic thrombi in 1 patient (6%). A total of 3 patients (19%) died within 6 months; 7 of 13 surviving patients still had residual neurologic deficits at the 6-month follow-up. Conclusions: Spondylodiscitis may be resistant to antibiotic treatment and may evolve into epidural abscess via extension of the infection and pus into the spinal canal, necessitating repetitive surgical treatment due to neurologic and clinical deterioration, and expansion of the persistent infection with a mass effect. Increased vigilance for this condition and its misleading initial presentations is warranted.
Frontiers in Surgery, 2020
Spinal epidural abscess (SEA) incidence is rising. However, most series do not differentiate between SEAs associated with pyogenic infectious spondylodiscitis (PS) and SEAs limited to the epidural space. Methods: We retrospectively reviewed the records and radiological images of all patients admitted to our institutions with a diagnosis of SEA not associated with PS between January 2013 and December 2018. Results: We found three males and four females; five of the seven were intravenous drug users. All patients presented with pain: in six, it was associated with acute motor and sensory deficits, while one had only pain and paresthesias. Staphylococcus aureus was cultured from abscesses and/or from multiple blood cultures in four patients. Abscesses were localized to the cervical spine in one patient, thoracic in three, lumbar in one, and in two, the SEAs involved multiple segments. All patients but one underwent urgent open surgery. This patient had a multisegmental abscess and was successfully treated by percutaneous aspiration when pain became intractable. After abscess evacuation, the neurological deficits improved in all patients except one. The patients that were treated without spine instrumentation did not develop delayed kyphosis or instability at follow-up. Conclusion: Patients with SEAs not associated with PS are likely to present with pain and motor deficits, appear to benefit from urgent abscess evacuation, and seem to be less dependent on spine instrumentation to avoid delayed spinal deformities compared to SEA associated with PS. Finally, the lack of initial involvement of bone and intervertebral disks may suggest that at least some of the SEAs without PS originate from infection of epidural lymphatic vessels that are not present inside those structures.
2018
Background: The study aimed to assess the effectiveness of antibiotic treatment for spondylodiscitis, its failure rates, and the need for surgical intervention. Methods: This is a retrospective study of patients who presented with spontaneous deep spinal infections and spondylodiscitis between 2011 and 2013. Clinical, bacteriologic, and radiographic data during hospitalization were analyzed. Results: A total of 16 patients presented with deep spinal infections during the study period; 15 of them presented with spontaneous pyogenic spondylodiscitis, and 1 presented with epidural abscess. Median age was 68 years (range, 50– 80 years), and 6 (38%) were healthy young laborers. None of the patients were immunocompromised. On admission all patients presented with pain, there was fever in 3 patients (19%), and there was elevated blood C-reactive protein, white blood cell count and erythrocyte sedimentation rate, with a mean of 147 6 83.1 mg/L, 11.65 6 5.6 3 10/lL, 93.6 6 35.1 mm/h, respect...
Infective endocarditis associated with spondylodiscitis and frequent secondary epidural abscess
Surgical Neurology, 2008
Background: Although many patients with IE complain of joint, muscle, and back pain, infections at these sights are rare. Indeed, in patients with back pain and endocarditis, less than 4% actually demonstrate spondylodiscitis. Case Description: We recently encountered 4 patients with this complication, one each caused by Staphylococcus aureus, Streptococcus bovis, Streptococcus mitis, and Enterococcus faecalis, and wondered whether the nature of the infecting organism determined the development of spondylodiscitis and epidural abscess. In a literature review, 36 patients with endocarditis and spondylodiscitis were identified. Only 9 (25%) were caused by Streptococcus viridans and the remainder by staphylococci, enterococci, and other streptococci. Usually more than 50% of all cases of IE were caused by Streptococcus viridans, although more recent studies would indicate an incidence of about 40%. Conclusion: We conclude that spondylodiscitis with epidural abscess is more likely to occur in those patients with endocarditis who are infected by organisms with pyogenic potential.
Acta Neurochirurgica, 2008
Pyogenic spondylodiscitis associated with epidural abscess is a rare but serious problem in spinal surgery, because it may cause a severe morbidity or mortality, if the diagnosis is established late and the treatment is inadequate. A case of pyogenic thoracic spondylodiscitis associated with epidural abscess whose symptoms progressed over two months from back pain to acute paraplegia was presented. Magnetic resonance imaging of the spine suggested the presence of T9–10 spondylodiscitis with partial destruction of the T9 and T10 vertebral bodies and concomitant epidural abscess. Treatment consisting of surgical debridement of infected vertebrae and disc material, fusion and anterior spinal instrumentation was performed. Microbiological culture of the material revealed infection with Staphylococcus aureus and after 3 months of antibiotic treatment, recovery was almost complete. Based on a thorough review of the literature and the case presented in this report, it is concluded that accurate and prompt diagnosis requires high index of suspicion followed by a combination of adequate surgical and conservative treatment prevents severe morbidity in cases of nonspecific pyogenic spondylodiscitis associated with epidural abscess.
Community Acquired Spondylodiscitis caused by Escherichia Coli; Case Report and Literature Review
Bulletin of emergency and trauma, 2016
Vertebral osteomyelitis, or spondylodiscitis, is a rare disease with increasing prevalence in recent years due to a greater number of spinal surgical procedures, nosocomial bacteraemia, an aging population and intravenous drug addiction. Haematogenous infection is the most common cause of spondylodiscitis. We report a 47-year-old man diagnosed with Escherichia coli spondylodiscitis. The patient initially presented with a 4-day history of inflammatory, mechanical pain in the lower back suggesting sciatica. Treatment included NSAIDs and opioids. Two days after discharge from hospital following an admission due to an upper GI bleeding, the back pain intensified, precipitating a new attendance to the emergency department; during which lumbosacral radiography showed marked reduction of L2/L3 intervertebral space. After a new admission to the rheumatology unit due to worsening of symptoms and raised inflammatory markers, an expedited MRI showed loss of intervertebral disc space at L2/L3, ...
Infectious spondylodiscitis: A twenty-year experience from a single tertiary referral center
The Egyptian Rheumatologist, 2018
Aim of the work: To study microbiological, clinical and therapeutic aspects of spondylodiscitis (SD) and predisposing risk factors in Tunisian patients. Patients and methods: Patients with SD admitted to Rheumatology Departments, Southern Tunisia, were retrospectively studied. Medical records were reviewed over the last 20-years and investigations included bacterial cultures, magnetic resonance imaging (MRI) or computed-tomography percutaneous disc biopsy (CT-PDB). Results: There were 67 SD cases (incidence of 0.17/100,000 inhabitants/year); 38 men and 29 women and mean age was 55 ± 16 years. Advanced age, tuberculosis and brucellar contagion were the predominant risk factors. The duration from onset to diagnosis was 133.6 ± 115 days. Low back pain (LBP) was the most common symptom. Lumbar spine was the most frequent location. Neurologic symptoms (radicular pain, spinal chord compression, neurologic loss) were observed in 31 patients. C-reactive protein was elevated in 54 (52.17 ± 43.97 mg/L). MRI showed abnormalities in 60 patients and CT-PDB was performed in 39. Pathogens were isolated in 43 cases. Mycobacterium tuberculosis (MT) was the most common (55.8%) followed by staphylococcus aureus (18.6%), brucella (16.3%), Escherichia coli (EC) (4.7%) and streptococcus-b in 1 patient; 1 patient had both MT and EC. Medical treatment was prescribed in 91% and surgery performed in 6. 88% of patients improved after 24 months follow-up. Conclusion: Spondylodiscitis should be considered for all patients presenting with chronic LBP with systemic symptoms and evidence inflammation. MRI is required to establish a diagnosis and evaluate the spread of infection. CT-PDB is useful to identify the causative microorganism before antibiotic administration. These findings could to pave the way for constructing national guidelines.