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Vertebral Osteomyelitis Caused by Mycobacterium abscessus Surgically Treated Using Antibacterial Iodine-Supported Instrumentation.

Kato S, Murakami H, Demura S, Yoshioka K, Hayashi H, Yokogawa N, Fang X, Tsuchiya H - Case Rep Orthop (2014)

Bottom Line: Her disease condition did not abate with conservative treatment using antimicrobial chemotherapy.Chemotherapy using clarithromycin, amikacin, and imipenem was applied for 6 months after surgery as these antibiotics had been proven to be effective to Mycobacterium abscessus after surgery.Two years after surgery, the infected anterior site healed and bony fusion was successfully achieved without a recurrence of infection.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa 920-8641, Japan.

ABSTRACT
Mycobacterium abscessus infections rarely develop in healthy individuals, and mostly they occur in immunocompromised hosts. Vertebral osteomyelitis due to Mycobacterium abscessus is very rare and only three previous cases of spinal infection caused by Mycobacterium abscessus have been reported. Mycobacterium abscessus isolates are uniformly resistant to antituberculous agents and can display a virulent biofilm-forming phenotype. The patient was a 67-year-old woman with vertebral osteomyelitis of the L1-2. She was healthy without immune-suppressed condition, history of trauma, or intravenous drug use. The smear examination of the specimen harvested by CT-guided puncture of the paravertebral abscess revealed Mycobacterium abscessus. Her disease condition did not abate with conservative treatment using antimicrobial chemotherapy. Radical debridement of the vertebral osteomyelitis and anterior reconstruction from T12 to L2 using antibacterial iodine-supported instrumentation were performed. Chemotherapy using clarithromycin, amikacin, and imipenem was applied for 6 months after surgery as these antibiotics had been proven to be effective to Mycobacterium abscessus after surgery. Two years after surgery, the infected anterior site healed and bony fusion was successfully achieved without a recurrence of infection.

No MeSH data available.


Related in: MedlinePlus

Computed tomography of the lumbar spine 2 years after surgery showing a bony fusion was successfully achieved without a recurrence of infection. (a) Sagittal view. (b) Coronal view.
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fig3: Computed tomography of the lumbar spine 2 years after surgery showing a bony fusion was successfully achieved without a recurrence of infection. (a) Sagittal view. (b) Coronal view.

Mentions: Radical debridement of the vertebral osteomyelitis of the L1 and L2 vertebral bodies and spinal reconstruction using iodine-supported instrumentation were performed using a right retroperitoneal approach. An autogenous bone graft harvested from the iliac crest and alpha-TCP paste mixed with imipenem were packed into an iodine-supported mesh cage. The mesh cage was inserted into the large defect after a radical debridement involving L1 corpectomy. Then, anterior fixation from T12 to L2 using antibacterial iodine-supported instrumentation was performed (Figure 2). Antimicrobial chemotherapy using clarithromycin for 6 months and amikacin and imipenem for 3 months at the same dose of the preoperative period was continued after surgery, as these antibiotics have been proven to be effective against Mycobacterium abscessus, which was identified on the culture examination of the specimen harvested during surgery. A hard brace was applied for 3 months after surgery. Laboratory findings at 3 months after surgery showed no evidence of inflammatory signs; white blood cell count was 5000/μL, C-reactive protein level was 0.1 mg/dL, and erythrocyte sedimentation rate was 4 mm/h. Two years after surgery, the infected anterior site had healed, and bony fusion was successfully achieved (Figure 3). The patient is now completely asymptomatic without a brace and has not had a recurrence of infection. No evidence of inflammatory signs has been apparent in subsequent laboratory examinations.


Vertebral Osteomyelitis Caused by Mycobacterium abscessus Surgically Treated Using Antibacterial Iodine-Supported Instrumentation.

Kato S, Murakami H, Demura S, Yoshioka K, Hayashi H, Yokogawa N, Fang X, Tsuchiya H - Case Rep Orthop (2014)

Computed tomography of the lumbar spine 2 years after surgery showing a bony fusion was successfully achieved without a recurrence of infection. (a) Sagittal view. (b) Coronal view.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4269211&req=5

fig3: Computed tomography of the lumbar spine 2 years after surgery showing a bony fusion was successfully achieved without a recurrence of infection. (a) Sagittal view. (b) Coronal view.
Mentions: Radical debridement of the vertebral osteomyelitis of the L1 and L2 vertebral bodies and spinal reconstruction using iodine-supported instrumentation were performed using a right retroperitoneal approach. An autogenous bone graft harvested from the iliac crest and alpha-TCP paste mixed with imipenem were packed into an iodine-supported mesh cage. The mesh cage was inserted into the large defect after a radical debridement involving L1 corpectomy. Then, anterior fixation from T12 to L2 using antibacterial iodine-supported instrumentation was performed (Figure 2). Antimicrobial chemotherapy using clarithromycin for 6 months and amikacin and imipenem for 3 months at the same dose of the preoperative period was continued after surgery, as these antibiotics have been proven to be effective against Mycobacterium abscessus, which was identified on the culture examination of the specimen harvested during surgery. A hard brace was applied for 3 months after surgery. Laboratory findings at 3 months after surgery showed no evidence of inflammatory signs; white blood cell count was 5000/μL, C-reactive protein level was 0.1 mg/dL, and erythrocyte sedimentation rate was 4 mm/h. Two years after surgery, the infected anterior site had healed, and bony fusion was successfully achieved (Figure 3). The patient is now completely asymptomatic without a brace and has not had a recurrence of infection. No evidence of inflammatory signs has been apparent in subsequent laboratory examinations.

Bottom Line: Her disease condition did not abate with conservative treatment using antimicrobial chemotherapy.Chemotherapy using clarithromycin, amikacin, and imipenem was applied for 6 months after surgery as these antibiotics had been proven to be effective to Mycobacterium abscessus after surgery.Two years after surgery, the infected anterior site healed and bony fusion was successfully achieved without a recurrence of infection.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa 920-8641, Japan.

ABSTRACT
Mycobacterium abscessus infections rarely develop in healthy individuals, and mostly they occur in immunocompromised hosts. Vertebral osteomyelitis due to Mycobacterium abscessus is very rare and only three previous cases of spinal infection caused by Mycobacterium abscessus have been reported. Mycobacterium abscessus isolates are uniformly resistant to antituberculous agents and can display a virulent biofilm-forming phenotype. The patient was a 67-year-old woman with vertebral osteomyelitis of the L1-2. She was healthy without immune-suppressed condition, history of trauma, or intravenous drug use. The smear examination of the specimen harvested by CT-guided puncture of the paravertebral abscess revealed Mycobacterium abscessus. Her disease condition did not abate with conservative treatment using antimicrobial chemotherapy. Radical debridement of the vertebral osteomyelitis and anterior reconstruction from T12 to L2 using antibacterial iodine-supported instrumentation were performed. Chemotherapy using clarithromycin, amikacin, and imipenem was applied for 6 months after surgery as these antibiotics had been proven to be effective to Mycobacterium abscessus after surgery. Two years after surgery, the infected anterior site healed and bony fusion was successfully achieved without a recurrence of infection.

No MeSH data available.


Related in: MedlinePlus