Nosocomial spondylodiskitis with epidural abscess and CSF fistula cured with quinupristin/dalfopristin and linezolid.
Nosocomial infections after spinal surgery are relatively uncommon but potentially serious. The goal of diagnostic evaluation is to determine the extent of infection and identify the microorganism involved. Neuroimaging provides accurate information on correct topography, localization and propagation of the infection. Microbiological data are able to give aetiological causes. In this patient with severe, chronic polymicrobial spine infection with epidural abscess and CSF fistula due to multidrug-resistant organisms, the cure was achieved with long-term antimicrobial specific therapy with quinupristin-dalfopristin (50 days) and linezolid (100 days) with mild side effects. This positive result was due to combined medical and surgical treatment.
Marroni
M
M
Department of Experimental Medicine and Biochemical Science, Section of Infectious Diseases, University of Perugia, Azienda Ospedaliera di Perugia, Italy.
Tinca
M
M
Belfiori
B
B
Altobelli
G
G
Malincarne
L
L
Papili
R
R
Stagni
G
G
D000081:Acetamides / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000302:isolation & purification; D002555:Cerebrospinal Fluid / Q000382:microbiology; D003131:Combined Modality Therapy; D003428:Cross Infection / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D003475:Curettage; D020878:Device Removal; D015299:Discitis / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D020802:Epidural Abscess / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D005260:Female; D005402:Fistula / Q000134:cerebrospinal fluid / Q000209:etiology / Q000382:microbiology; D015725:Fluconazole / Q000627:therapeutic use; D005658:Fungi / Q000302:isolation & purification; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects; D007796:Laminectomy; D000069349:Linezolid; D008159:Lumbar Vertebrae / Q000382:microbiology*; D000077731:Meropenem; D016106:Methicillin Resistance; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology / Q000382:microbiology; D023303:Oxazolidinones / Q000627:therapeutic use*; D010300:Parkinson Disease / Q000150:complications; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology / Q000601:surgery; D012086:Reoperation; D012871:Skin Diseases / Q000134:cerebrospinal fluid / Q000209:etiology / Q000382:microbiology; D013122:Spinal Diseases / Q000134:cerebrospinal fluid / Q000209:etiology / Q000382:microbiology; D013130:Spinal Stenosis / Q000150:complications / Q000601:surgery; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D013845:Thienamycins / Q000627:therapeutic use; D014769:Virginiamycin / Q000627:therapeutic use*
D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D013845:Thienamycins; D014769:Virginiamycin; C062940:quinupristin-dalfopristin; D015725:Fluconazole; D000077731:Meropenem; D000069349:Linezolid