Osteomyelitis of the spine: treatments and future directions

Mehkri, Yusuf; Felisma, Patrick; Panther, Eric; Lucke‐Wold, Brandon

doi:10.53388/idr20220117003

Cited by 14 publications

(10 citation statements)

References 61 publications

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“…At the same time, given that Brucella infection has similar symptoms as TB infection, the patients went to TB-specialized hospitals for treatment. Opportunistic pathogens also account for a certain proportion of cases with non-TB bacterial spinal infections ( Gupta et al, 2022 ; Mehkri et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic efficiency of metagenomic next-generation sequencing for suspected spinal tuberculosis in China: A multicenter prospective study

Yao²,

Tang³

et al. 2022

Front. Microbiol.

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BackgroundThe pathogens of suspected spinal tuberculosis (TB) include TB and non-TB bacteria. A rapid and effective diagnostic method that can detect TB and non-TB pathogens simultaneously remains lacking. Here, we used metagenomic next-generation sequencing (mNGS) to detect the pathogens in patients with suspected spinal TB.MethodsThe enrolled patients with suspected spinal TB were regrouped three times into patients with spinal infection and controls, patients with spinal TB and controls, and patients with non-TB spinal infection and controls. We tested the three groups separately by using mNGS and conventional detection methods.ResultsUltimately, 100 patients were included in this study. Pathogens were detected in 82 patients. Among the 82 patients, 37 had TB and 45 were infected with other bacteria. In patients with spinal infection, the sensitivity of the mNGS assay was higher than that of culture and pathological examination (p < 0.001, p < 0.001). The specificity of the mNGS assay was not statistically different from that of culture and pathological examination (p = 1.000, p = 1.000). In patients with spinal TB, no statistical difference was found between the sensitivity of the mNGS assay and that of Xpert and T-SPOT.TB (p = 1.000, p = 0.430). The sensitivity of the mNGS assay was higher than that of MGIT 960 culture and pathological examination (p < 0.001, p = 0.006). The specificities of the mNGS assay, Xpert, MGIT 960 culture, and pathological examination were all 100%. The specificity of T-SPOT.TB (78.3%) was lower than that of the mNGS assay (100%; p < 0.001). In patients with non-TB spinal infection, the sensitivity of the mNGS assay was higher than that of bacterial culture and pathological examination (p < 0.001, p < 0.001). The specificity of the mNGS assay was not statistically different from that of bacterial culture and pathological examination (p = 1.000, p = 1.000).ConclusionData presented here demonstrated that mNGS can detect TB and non-TB bacteria simultaneously, with high sensitivity, specificity and short detection time. Compared with conventional detection methods, mNGS is a more rapid and effective diagnostic tool for suspected spinal TB.

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Section: Discussionmentioning

confidence: 99%

Diagnostic efficiency of metagenomic next-generation sequencing for suspected spinal tuberculosis in China: A multicenter prospective study

Yao²,

Tang³

et al. 2022

Front. Microbiol.

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“…Our second key finding is that treatment combining anterior-posterior fixation with retroperitoneal CLAP was effective for PVO with iliopsoas and epidural abscesses. Conventional surgical treatments can sometimes result in poor outcomes [ 2 ]. Factors like advanced age, diabetes mellitus, and immunocompromised conditions are associated with severe symptoms of PVO [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal Continuous Local Antibiotic Perfusion for Refractory Pyogenic Vertebral Osteomyelitis: A Case Report

Ohyama,

Inoue,

Toshi

et al. 2023

Cureus

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Pyogenic vertebral osteomyelitis (PVO) is a prevalent infection in the elderly, frequently complicated by iliopsoas and epidural abscesses. Traditional treatments are often ineffective for refractory cases. In this report, a 76-year-old man with PVO, iliopsoas, and epidural abscess was unresponsive to antibiotics, presenting with severe lower back pain and functional impairments. A two-stage surgical intervention was implemented: anterior debridement, autogenous bone graft fixation, and novel application of retroperitoneal continuous local antibiotic perfusion (CLAP), followed by posterior fixation. A contrast test verified correct CLAP perfusion into the iliopsoas abscess and intervertebral disc space. Substantial improvements were noted postoperatively, including a marked reduction in pain, inflammation, and the size of both abscesses. In conclusion, this case demonstrates the feasibility and effectiveness of retroperitoneal CLAP in treating refractory PVO, offering a potential innovative solution for cases resistant to conventional therapies.

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“…OM, especially haematogenous OM, can cause an excessive inflammatory response in blood vessels and coagulation disorders modulated by various microorganisms [ 25 , 26 ]. S. aureus is the predominant causative pathogen of OM [ 27 ]. Surface proteins and exotoxins of S. aureus can trigger thrombosis through effects on the coagulation pathway and on anticoagulation factors.…”

Section: Discussionmentioning

confidence: 99%

The Underlying Molecular Basis and Mechanisms of Venous Thrombosis in Patients with Osteomyelitis: A Data-Driven Analysis

et al. 2022

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Objective. Osteomyelitis (OM) is one of the most risky and challenging diseases. Emerging evidence indicates OM is a risk factor for increasing incidence of venous thromboembolism (VTE) development. However, the mechanisms have not been intensively investigated. Methods. The OM-related dataset GSE30119 and VTE-related datasets GSE19151 and GSE48000 were downloaded from the Gene Expression Omnibus (GEO) database and analyzed to identify the differentially expressed genes (DEGs) (OMGs1 and VTEGs1, respectively). Functional enrichment analyses of Gene Ontology (GO) terms were performed. VTEGs2 and OMGs2 sharing the common GO biological process (GO-BP) ontology between OMGs1 and VTEGs1 were detected. The TRRUST database was used to identify the upstream transcription factors (TFs) that regulate VTEGs2 and OMGs2. The protein-protein interaction (PPI) network between VTEGs2 and OMGs2 was constructed using the Search Tool for the Retrieval of Interacting Genes (STRING) database and then visualized in Cytoscape. Topological properties of the PPI network were calculated by NetworkAnalyzer. The Molecular Complex Detection (MCODE) plugin was utilized to perform module analysis and choose the hub modules of the PPI network. Results. A total of 587 OMGs1 and 382 VTEGs1 were identified from the related dataset, respectively. GO-BP terms of OMGs1 and shared DGEs1 were mainly enriched in the neutrophil-related immune response process, and the shared GO-BP terms of OMGs1 and VTEGs1 seemed to be focused on cell activation, immune, defense, and inflammatory response to stress or biotic stimulus. 230 VTEGs2, 333 OMGs2, and 13 shared DEGs2 were detected. 3 TF-target gene pairs (SP1-LSP1, SPI1-FCGR1A, and STAT1-FCGR1A) were identified. The PPI network contained 1611 interactions among 467 nodes. The top 10 hub proteins were TP53, IL4, MPO, ELANE, FOS, CD86, HP, SOCS3, ICAM1, and SNRPG. Several core nodes (such as MPO, ELANE, and CAMP) were essential components of the neutrophil extracellular traps (NETs) network. Conclusion. This is the first data-mining study to explore shared signatures between OM and VTE by the integrated bioinformatic approach, which can help uncover potential biomarkers and therapeutic targets of OM-related VTE.

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Osteomyelitis of the spine: treatments and future directions

Cited by 14 publications

References 61 publications

Diagnostic efficiency of metagenomic next-generation sequencing for suspected spinal tuberculosis in China: A multicenter prospective study

Diagnostic efficiency of metagenomic next-generation sequencing for suspected spinal tuberculosis in China: A multicenter prospective study

Retroperitoneal Continuous Local Antibiotic Perfusion for Refractory Pyogenic Vertebral Osteomyelitis: A Case Report

The Underlying Molecular Basis and Mechanisms of Venous Thrombosis in Patients with Osteomyelitis: A Data-Driven Analysis

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