Patient: Male, 58Final Diagnosis: Vertebral osteomyelitisSymptoms: Back painMedication: DalbavancinClinical Procedure: —Specialty: Infectious DiseaseObjective:Unusual clinical courseBackground:Native vertebral osteomyelitis (NVO) is a common form of hematogenous osteomyelitis, with Staphylococcus aureus (S. aureus) being the most commonly isolated organism. Dalbavancin is approved by the US Food and Drug Administration (FDA) for the treatment of acute bacterial skin and skin structure infections (ABSSSI) and has a sufficiently promising pharmacokinetic and pharmacodynamic profile to be considered for the treatment of vertebral osteomyelitis. We describe here what is probably the first reported case of using multiple weekly dalbavancin to treat a complicated methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and vertebral osteomyelitis.Case Report:A 58-year-old man with a long history of recurrent MRSA bacteremia, who failed multiple courses of vancomycin and daptomycin, presented with recurrent MRSA bacteremia complicated by diskitis and osteomyelitis of the lumbar vertebrae. The patient was treated with dalbavancin 1000 mg intravenously weekly for two weeks followed by 500 mg weekly for six additional weeks. He improved clinically, his back pain resolved, and C-reactive protein (CRP) decreased to normal. Three months after the last dose of dalbavancin therapy, he underwent angiography for peripheral artery diseases, after which he developed a fever, mild leukocytosis, an elevated CRP, and the repeat blood cultures were positive for MRSA. No apparent adverse events were observed during dalbavancin therapy.Conclusions:In this case, multiple weekly dalbavancin infusions appeared to be safe in the treatment of vertebral osteomyelitis caused by MRSA, but did not seem to prevent infection recurrence. However, reinfection with a new strain from the angiography catheter insertion is highly likely. Clinical studies are needed to further assess the safety and effectiveness of multiple weekly dalbavancin dosing in the management of vertebral osteomyelitis.

This paper describes the planning and implementation of an individualized teaching programme for patients and their families following primary uncomplicated myocardial infarction. This preliminary study was designed and implemented by a senior nurse while working in the clinical area. Patients were randomly allocated to a control or study group. Both groups of patients were interviewed on the fourth day following admission to hospital and again at 2 and 6 months after discharge. Nurse intervention in the form of individually planned consecutive teaching sessions achieved a reduction in anxiety and modification of identifiable risk factors (smoking, obesity, diet, exercise) in the patients included in the teaching programme.

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To a non-lawyer, references to law reports can appear confusing and complicated. This briefarticle attempts to explain how to decode such references and thus get to the reports. Those wishing to pursue the matterfurther are referred to more detailed explanations. This article deals primarily with English case law and is up to date as of December 1987. How to find a case (when you know the reference) Cases are referred to by the names of the parties involved in the action. For example: