bWe conducted a retrospective cohort study to evaluate factors influencing tissue culture positivity in patients with pyogenic vertebral osteomyelitis exposed to antibiotics before diagnosis. Tissue culture was positive in 48.3% (28/58) of the patients, and the median antibiotic-free period was 1.5 days (range, 0.7 to 5.7 days). In a multivariate analysis, a higher C-reactive protein (CRP) level (adjusted odds ratio [aOR], 1.18; 95% confidence interval, 1.07 to 1.29) and open surgical biopsy (aOR, 6.33; 95% confidence interval, 1.12 to 35.86) were associated with tissue culture positivity. If pyogenic vertebral osteomyelitis (PVO) is suspected, tissue cultures and/or blood cultures are recommended (1). Prior antibiotic exposure has been reported in some studies to have a negative effect on microbiologic diagnosis (2-5). In view of this, it is recommended that, for clinically stable patients, biopsy be delayed until at least 48 h after the last antibiotic has been administered (6). The aims of this study were to investigate the factors influencing tissue culture positivity in patients with PVO who were exposed to antibiotics prior to biopsy and to establish whether an antibiotic-free period improves culture positivity rates.We conducted a retrospective cohort study at three universityaffiliated teaching hospitals from May 2012 through February 2014. Patients with PVO who had been exposed to antibiotics during the 2 weeks before the acquisition of tissue culture specimens were investigated. Patients who were Ͻ18 years old and patients with infectious spondylitis caused by Mycobacterium tuberculosis or fungi were excluded. PVO was diagnosed when the causative microorganism was isolated from spinal or paraspinal tissues or if there were compatible clinical signs or symptoms and radiologic evidence of vertebral infection as described previously (7). The antibiotic-free period was defined as the time interval between the administration of the latest antibiotic and acquisition of specimens for tissue culture. If the antibiotic administered was not active on the microorganism eventually isolated, the patient was considered not to have been exposed to antibiotics. Tissue culture specimens were acquired by percutaneous biopsy or open surgical biopsy. The latter was performed during surgical treatment of the PVO. The Mann-Whitney U test was used to compare continuous variables, and the chi-square test was used to compare categorical variables. Multivariate analysis was performed with binary logistic regression to investigate the factors influencing tissue culture positivity. All P values were two tailed, and P Ͻ 0.05 was considered statistically significant.During the study period, a total of 58 patients with PVO received antibiotics before the acquisition of tissue culture specimens. Blood cultures were done for 53 patients, and 30.2% (16/ 53) gave positive results. The tissue culture positivity rate was 48.3% (28/58). Tissue culture specimens of 48 patients were obtained by computed-tomography or fluoroscopy-guided percu...

BackgroundA substantial portion of Clostridium difficile infection (CDI) cases occur in communities, and community-onset CDI (CO-CDI) can lead to serious complications including mortality. This study aimed to identify the risk factors for a poor outcome in CO-CDI.MethodsWe performed a retrospective review of all inpatients with CDI, in a 1300-bed tertiary-care hospital in Korea, from 2008 through 2015. CO-CDI was defined as CDI occurring within 48 h of admission. Poor outcome was defined as follows: 1) all-cause 30-day mortality, 2) in-hospital mortality, or 3) surgery due to CDI.ResultsOf a total 1256 CDIs occurring over 8 years, 152 (12.1%) cases were classified as CO-CDI and 23 (15.1%) had a poor outcome, including 22 (14.5%) cases of mortality and 2 (1.3%) cases of surgery. Patients with a poor outcome had a higher mean age than those without a poor outcome (75.8 vs. 69.6 years, p = 0.03). The proportion of men and prior proton pump inhibitor (PPI) use were significantly higher in the poor outcome group (65.2% vs. 41.9%, p = 0.04; 39.1% vs. 17.6%, p = 0.02, respectively). Multivariate binary logistic model showed that PPI use and anemia (hemoglobin < 10 g/dL) at presentation were significantly associated with a poor outcome (adjusted odds ratio [aOR], 3.76; 95% confidence interval [95CI], 1.26–11.21, aOR, 4.67; 95CI, 1.52–14.34, respectively).ConclusionsClinicians should not only be aware of the possibility of CDI in the community setting but also pay more attention to PPI-using elderly patients with anemia in consideration of a poor outcome.Electronic supplementary materialThe online version of this article (10.1186/s13756-018-0365-6) contains supplementary material, which is available to authorized users.

BackgroundDespite vancomycin use is a major risk factor for the emergence of vancomycin resistance, it is frequently inappropriately prescribed, especially as empirical treatment. We evaluated the effect of an antimicrobial stewardship intervention targeting for inappropriate continued empirical vancomycin use.MethodsThis was a quasi-experimental study comparing vancomycin use in a 6-month pre-intervention and 6-month intervention period. If empirical vancomycin was continued for more than 96 h without documentation of beta-lactam-resistant gram-positive microorganisms, it was considered inappropriate continued empirical vancomycin use. The intervention consisted of the monitoring of appropriateness by a pharmacist and direct discussion with the prescribing physicians by infectious disease specialists when empirical vancomycin was continued inappropriately. An interrupted time series analysis was used to compare vancomycin use before and during the intervention.ResultsFollowing implementation of the intervention, overall vancomycin consumption decreased by 14.6%, from 37.6 defined daily doses (DDDs)/1000 patient-days in the pre-intervention period to 32.1 DDDs/1000 patient-days in the intervention period (P <  0.001). The inappropriate consumption of vancomycin also declined from 8.0 DDDs/1000 patient-days to 5.8 DDDs/1000 patient-days (P = 0.009).ConclusionInterventions such as direct communication with prescribing physicians and infectious disease clinicians can help reduce the inappropriate continued use of vancomycin.

A 70-year-old man presented with lower back pain and cyanotic changes in his left lower extremity. He was diagnosed with infected aortic aneurysm and infectious spondylitis. He had received intravesical Bacillus Calmette-Guérin (BCG) therapy up to 1 month before the onset of symptoms. The aneurysm was excised and an aorto-biiliac interposition graft was performed. Mycobacterium tuberculosis complex was cultured in the surgical specimens. Real-time polymerase chain reaction (PCR) targeting the senX3-regX3 region, and multiplex PCR using dual-priming oligonucleotide primers targeting the RD1 gene, revealed that the organism isolated was Mycobacterium bovis BCG. The patient took anti-tuberculosis medication for 1 year, and there was no evidence of recurrence at 18 months follow-up.

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