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Didier Raoult - One of the best experts on this subject based on the ideXlab platform.
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Coxiella burnetii Multilevel Disk Space Infection, Epidural Abscess, and Vertebral Osteomyelitis Secondary to Contiguous Spread From Infected Abdominal Aortic Aneurysm or Graft: Report of 4 Cases Acquired in the US and Review of the Literature
Open Forum Infectious Diseases, 2017Co-Authors: Abinash Virk, Thomas C Bower, Manju Kalra, Maryam Mahmood, Douglas R. Osmon, Elie F. Berbari, Didier RaoultAbstract:Background. Chronic Coxiella burnetii infections such as vertebral osteomyelitis caused by contiguous spread from an infected abdominal Aortic Graft or aneurysm have been rarely reported and are associated with significant morbidity and mortality. Methods. We present the first four reported US acquired cases of Coxiella burnetii vertebral osteomyelitis caused by contiguous spread from an infected abdominal Aortic Graft or aneurysm. Results. Presenting symptoms included progressive back pain, malaise, and weight loss with recent or remote animal exposure. Typical imaging findings demonstrated a peri-Aortic collection with extension to the paraspinal muscles and vertebrae. Antibiotic regimens included doxycycline with either hydroxychloroquine or a quinolone for at least 2 years or as chronic suppression. Conclusions. C. burnetii vertebral osteomyelitis is rare and can occur by contiguous spread from an abdominal aneurysm or vascular Graft infection. It should be suspected in patients where pre-antibiotic cultures are negative with animal/ farming exposure.
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Prosthetic Valve Endocarditis Caused by Bartonella henselae: A Case Report of Molecular Diagnostics Informing Nonsurgical Management
Open Forum Infectious Diseases, 2016Co-Authors: Patricia Bartley, Emmanouil Angelakis, Didier Raoult, Rangarajan Sampath, Robert A. Bonomo, Robin L. P. JumpAbstract:Identifying the pathogen responsible for culture-negative valve endocarditis often depends on molecular studies performed on surgical specimens. A patient with Ehlers-Danlos syndrome who had an Aortic Graft, a mechanical Aortic valve, and a mitral anulloplasty ring presented with culture-negative prosthetic valve endocarditis and Aortic Graft infection. Research-based polymerase chain reaction (PCR)/electrospray ionization mass spectrometry on peripheral blood samples identified Bartonella henselae. Quantitative PCR targeting the16S-23S ribonucleic acid intergenic region and Western immunoblotting confirmed this result. This, in turn, permitted early initiation of pathogen-directed therapy and subsequent successful medical management of B henselae prosthetic valve endocarditis and Aortic Graft infection.
Thomas C Bower - One of the best experts on this subject based on the ideXlab platform.
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Coxiella burnetii Multilevel Disk Space Infection, Epidural Abscess, and Vertebral Osteomyelitis Secondary to Contiguous Spread From Infected Abdominal Aortic Aneurysm or Graft: Report of 4 Cases Acquired in the US and Review of the Literature
Open Forum Infectious Diseases, 2017Co-Authors: Abinash Virk, Thomas C Bower, Manju Kalra, Maryam Mahmood, Douglas R. Osmon, Elie F. Berbari, Didier RaoultAbstract:Background. Chronic Coxiella burnetii infections such as vertebral osteomyelitis caused by contiguous spread from an infected abdominal Aortic Graft or aneurysm have been rarely reported and are associated with significant morbidity and mortality. Methods. We present the first four reported US acquired cases of Coxiella burnetii vertebral osteomyelitis caused by contiguous spread from an infected abdominal Aortic Graft or aneurysm. Results. Presenting symptoms included progressive back pain, malaise, and weight loss with recent or remote animal exposure. Typical imaging findings demonstrated a peri-Aortic collection with extension to the paraspinal muscles and vertebrae. Antibiotic regimens included doxycycline with either hydroxychloroquine or a quinolone for at least 2 years or as chronic suppression. Conclusions. C. burnetii vertebral osteomyelitis is rare and can occur by contiguous spread from an abdominal aneurysm or vascular Graft infection. It should be suspected in patients where pre-antibiotic cultures are negative with animal/ farming exposure.
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in situ rifampin soaked Grafts with omental coverage and antibiotic suppression are durable with low reinfection rates in patients with Aortic Graft enteric erosion or fistula
Journal of Vascular Surgery, 2011Co-Authors: Gustavo S. Oderich, Thomas C Bower, Manju Kalra, Jan Hofer, Audra A Duncan, John W Wilson, Stephan Cha, Peter GloviczkiAbstract:Objective We previously reported that in situ rifampin-soaked Grafts (ISRGs) were safe in select patients with Aortic Graft infections, with the best results in those with Aortic Graft enteric erosion or fistula (AGEF). This study evaluates the late results of ISRG for AGEF. Methods From 1990 to 2008, 183 patients were treated for Aortic Graft infections (121 primary and 62 AGEF). We reviewed 54 patients treated for AGEF with a standard protocol, which included excision of the infected part of the Graft, intestinal repair, ISRG with omental wrap, and long-term antibiotics. We excluded 8 patients with AGEF (13%) treated with axillofemoral Grafts (AXFG, n=5) or in situ femoral vein (n = 3) due to excessive periGraft purulence. Endpoints were early morbidity and mortality, late survival, reinfection, and Graft-related complications. Results There were 45 male patients and 9 female patients with a mean age of 69 ± 9 years. Presentation was gastrointestinal bleeding in 33 patients, fever in 25 patients, and hemorrhagic shock in 10 patients. Other features were periGraft fluid in 29 patients and purulence in 9 patients. Forty-two patients (80%) had infections isolated to a portion of the Graft body or limb, with the remainder of the Graft well incorporated. Total Graft excision was performed in 31 patients and partial excision in 23 patients. Total operating time was 6.2 ± 1.9 hours. Postoperative complications occurred in 28 patients (52%), and there were 5 deaths (9%). Operative mortality was 2.3% in stable patients (1 of 44) and 40% in those with hemorrhagic shock (4 of 10; P Conclusion ISRGs with omental wrap and long-term antibiotics are associated with low reinfection rates in patients with AGEF who do not have excessive periGraft purulence. Graft patency and limb salvage rates are excellent.
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evolution from axillofemoral to in situ prosthetic reconstruction for the treatment of Aortic Graft infections at a single center
Journal of Vascular Surgery, 2006Co-Authors: Gustavo S. Oderich, Kenneth J Cherry, Thomas C Bower, Jean M Panneton, Timothy M Sullivan, Audra A Noel, Michele Carmo, Stephen S Cha, Manju Kalra, Peter GloviczkiAbstract:Objective The primary purpose of this study was to analyze the clinical outcome in patients treated for Aortic Graft infections with in situ reconstruction (ISR). As a secondary aim, the outcomes were compared between patients who had similar clinical characteristics and extent of infection, needed total Graft excision, and had either ISR or axillofemoral reconstruction (AXFR). Methods 117 consecutive patients treated for Aortic Graft infection over a 20 year period from January 1981 to December 2001 were identified. 52 patients had prosthetic ISR, 49 had AXFR, and 16 had other reconstructions. The ISR patients treated with total (n = 35) or partial (n = 17) Graft excision comprised the primary analysis. A second analysis was done between 34 ISR and 43 AXFR patients (non-concurrent groups), as stated above. Primary outcome measures were early and late procedure-related death, primary Graft patency and limb loss. Secondary outcomes were operative morbidity, patient survival, and Graft reinfection rates. Results There were 40 males and 12 females with a mean age of 69 years treated with ISR. 43 patients had Rifampin-soaked Grafts and 39 had omental flap or other autogenous coverage. Operative morbidity occurred in 23 patients (44%). There were 4 early and no late procedure-related deaths after a median follow up of 3.4 years (range, 2 months to 9.6 years). Primary patency and limb salvage rates at 5 years were 89% and 100%, respectively. Graft reinfection occurred in 6 patients (11.5%) and was not associated with procedure-related death. In the comparative analysis, the procedure-related death rate for patients treated with ISR was not different than those treated with AXFR (9% versus 23%; P=0.11). There was a significant improvement in primary patency between ISR and AXFR at 5 years (89% versus 48%; P=.01). Limb salvage was 100% for ISR and 89% for AXFR at 5 years (P = .06). The incidence of Graft reinfection was similar in both groups: 11% for ISR and 17% for AXFR ( P = .28). Major complications or procedure-related deaths occurred in 12 patients after ISR (30%) and 26 patients (60%) after AXFR ( P Conclusion ISR is a safe and effective alternative in the treatment of select patients with Aortic Graft infection. Graft reinfection occurred in 11.5% of the patients. The Graft patency and limb salvages rates are excellent.
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the results of in situ prosthetic replacement for infected Aortic Grafts
American Journal of Surgery, 1999Co-Authors: Richard M Young, Kenneth J Cherry, Michael P Davis, Peter Gloviczki, Thomas C Bower, Jean M Panneton, John W HallettAbstract:BACKGROUND: Treatment of Aortic Graft infection with Graft excision and axillofemoral bypass may carry an increased risk of limb loss, Aortic stump blowout, and pelvic ischemia. A review of patients with Aortic Graft infection treated with in situ prosthetic Graft replacement was undertaken to determine if mortality, limb loss, and reinfection rates were improved with this technique. METHODS: The clinical data of 25 patients, 19 males and 6 females, with a mean age of 68 years (range 35 to 83), with Aortic Graft infection, treated between January 1, 1989, and December 31, 1998, by in situ prosthetic Graft replacement were reviewed. Follow-up was complete in the 23 surviving patients and averaged 36 months (range 4 to 103). RESULTS: Twenty aortofemoral, 3 aortoiliac, and 2 straight Aortic Graft infections were treated with excision and in situ replacement with standard polyester Grafts in 16 patients (64%), or with rifampin-soaked collagen or gelatin-impregnated polyester Grafts in 9 patients (36%). Fifteen patients (60%) had Aortic Graft enteric fistulas, 8 patients (32%) had abscesses or draining sinuses, and 2 patients (8%) had bacterial biofilm infections. Thirty-day mortality was 8% (2 of 25). There were no early Graft occlusions or amputations. There was one late Graft occlusion. There were no late amputations. The reinfection rate was 22% (5 Grafts). All reinfections occurred in patients operated upon for occlusive disease. Only one reinfection occurred in the rifampin-soaked Graft group (11% versus 29%, P = NS). Reinfection tended to be lower in patients with aortoenteric fistulas and without abscess. Autogenous tissue coverage provided statistically significant protection against reinfection. There were no late deaths related to in situ Graft infection. CONCLUSIONS: Patients treated with in situ Graft replacement had an 8% mortality and 100% limb salvage rate. Reinfection rates were similar to those of extra-anatomic bypass, but a trend of lower reinfection rates with rifampin-impregnated Grafts was apparent. Patients with aortoenteric fistula and without abscess appear to be well treated by the technique of in situ prosthetic Grafting and autogenous tissue coverage.
Manju Kalra - One of the best experts on this subject based on the ideXlab platform.
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Coxiella burnetii Multilevel Disk Space Infection, Epidural Abscess, and Vertebral Osteomyelitis Secondary to Contiguous Spread From Infected Abdominal Aortic Aneurysm or Graft: Report of 4 Cases Acquired in the US and Review of the Literature
Open Forum Infectious Diseases, 2017Co-Authors: Abinash Virk, Thomas C Bower, Manju Kalra, Maryam Mahmood, Douglas R. Osmon, Elie F. Berbari, Didier RaoultAbstract:Background. Chronic Coxiella burnetii infections such as vertebral osteomyelitis caused by contiguous spread from an infected abdominal Aortic Graft or aneurysm have been rarely reported and are associated with significant morbidity and mortality. Methods. We present the first four reported US acquired cases of Coxiella burnetii vertebral osteomyelitis caused by contiguous spread from an infected abdominal Aortic Graft or aneurysm. Results. Presenting symptoms included progressive back pain, malaise, and weight loss with recent or remote animal exposure. Typical imaging findings demonstrated a peri-Aortic collection with extension to the paraspinal muscles and vertebrae. Antibiotic regimens included doxycycline with either hydroxychloroquine or a quinolone for at least 2 years or as chronic suppression. Conclusions. C. burnetii vertebral osteomyelitis is rare and can occur by contiguous spread from an abdominal aneurysm or vascular Graft infection. It should be suspected in patients where pre-antibiotic cultures are negative with animal/ farming exposure.
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in situ rifampin soaked Grafts with omental coverage and antibiotic suppression are durable with low reinfection rates in patients with Aortic Graft enteric erosion or fistula
Journal of Vascular Surgery, 2011Co-Authors: Gustavo S. Oderich, Thomas C Bower, Manju Kalra, Jan Hofer, Audra A Duncan, John W Wilson, Stephan Cha, Peter GloviczkiAbstract:Objective We previously reported that in situ rifampin-soaked Grafts (ISRGs) were safe in select patients with Aortic Graft infections, with the best results in those with Aortic Graft enteric erosion or fistula (AGEF). This study evaluates the late results of ISRG for AGEF. Methods From 1990 to 2008, 183 patients were treated for Aortic Graft infections (121 primary and 62 AGEF). We reviewed 54 patients treated for AGEF with a standard protocol, which included excision of the infected part of the Graft, intestinal repair, ISRG with omental wrap, and long-term antibiotics. We excluded 8 patients with AGEF (13%) treated with axillofemoral Grafts (AXFG, n=5) or in situ femoral vein (n = 3) due to excessive periGraft purulence. Endpoints were early morbidity and mortality, late survival, reinfection, and Graft-related complications. Results There were 45 male patients and 9 female patients with a mean age of 69 ± 9 years. Presentation was gastrointestinal bleeding in 33 patients, fever in 25 patients, and hemorrhagic shock in 10 patients. Other features were periGraft fluid in 29 patients and purulence in 9 patients. Forty-two patients (80%) had infections isolated to a portion of the Graft body or limb, with the remainder of the Graft well incorporated. Total Graft excision was performed in 31 patients and partial excision in 23 patients. Total operating time was 6.2 ± 1.9 hours. Postoperative complications occurred in 28 patients (52%), and there were 5 deaths (9%). Operative mortality was 2.3% in stable patients (1 of 44) and 40% in those with hemorrhagic shock (4 of 10; P Conclusion ISRGs with omental wrap and long-term antibiotics are associated with low reinfection rates in patients with AGEF who do not have excessive periGraft purulence. Graft patency and limb salvage rates are excellent.
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evolution from axillofemoral to in situ prosthetic reconstruction for the treatment of Aortic Graft infections at a single center
Journal of Vascular Surgery, 2006Co-Authors: Gustavo S. Oderich, Kenneth J Cherry, Thomas C Bower, Jean M Panneton, Timothy M Sullivan, Audra A Noel, Michele Carmo, Stephen S Cha, Manju Kalra, Peter GloviczkiAbstract:Objective The primary purpose of this study was to analyze the clinical outcome in patients treated for Aortic Graft infections with in situ reconstruction (ISR). As a secondary aim, the outcomes were compared between patients who had similar clinical characteristics and extent of infection, needed total Graft excision, and had either ISR or axillofemoral reconstruction (AXFR). Methods 117 consecutive patients treated for Aortic Graft infection over a 20 year period from January 1981 to December 2001 were identified. 52 patients had prosthetic ISR, 49 had AXFR, and 16 had other reconstructions. The ISR patients treated with total (n = 35) or partial (n = 17) Graft excision comprised the primary analysis. A second analysis was done between 34 ISR and 43 AXFR patients (non-concurrent groups), as stated above. Primary outcome measures were early and late procedure-related death, primary Graft patency and limb loss. Secondary outcomes were operative morbidity, patient survival, and Graft reinfection rates. Results There were 40 males and 12 females with a mean age of 69 years treated with ISR. 43 patients had Rifampin-soaked Grafts and 39 had omental flap or other autogenous coverage. Operative morbidity occurred in 23 patients (44%). There were 4 early and no late procedure-related deaths after a median follow up of 3.4 years (range, 2 months to 9.6 years). Primary patency and limb salvage rates at 5 years were 89% and 100%, respectively. Graft reinfection occurred in 6 patients (11.5%) and was not associated with procedure-related death. In the comparative analysis, the procedure-related death rate for patients treated with ISR was not different than those treated with AXFR (9% versus 23%; P=0.11). There was a significant improvement in primary patency between ISR and AXFR at 5 years (89% versus 48%; P=.01). Limb salvage was 100% for ISR and 89% for AXFR at 5 years (P = .06). The incidence of Graft reinfection was similar in both groups: 11% for ISR and 17% for AXFR ( P = .28). Major complications or procedure-related deaths occurred in 12 patients after ISR (30%) and 26 patients (60%) after AXFR ( P Conclusion ISR is a safe and effective alternative in the treatment of select patients with Aortic Graft infection. Graft reinfection occurred in 11.5% of the patients. The Graft patency and limb salvages rates are excellent.
Abinash Virk - One of the best experts on this subject based on the ideXlab platform.
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Coxiella burnetii Multilevel Disk Space Infection, Epidural Abscess, and Vertebral Osteomyelitis Secondary to Contiguous Spread From Infected Abdominal Aortic Aneurysm or Graft: Report of 4 Cases Acquired in the US and Review of the Literature
Open Forum Infectious Diseases, 2017Co-Authors: Abinash Virk, Thomas C Bower, Manju Kalra, Maryam Mahmood, Douglas R. Osmon, Elie F. Berbari, Didier RaoultAbstract:Background. Chronic Coxiella burnetii infections such as vertebral osteomyelitis caused by contiguous spread from an infected abdominal Aortic Graft or aneurysm have been rarely reported and are associated with significant morbidity and mortality. Methods. We present the first four reported US acquired cases of Coxiella burnetii vertebral osteomyelitis caused by contiguous spread from an infected abdominal Aortic Graft or aneurysm. Results. Presenting symptoms included progressive back pain, malaise, and weight loss with recent or remote animal exposure. Typical imaging findings demonstrated a peri-Aortic collection with extension to the paraspinal muscles and vertebrae. Antibiotic regimens included doxycycline with either hydroxychloroquine or a quinolone for at least 2 years or as chronic suppression. Conclusions. C. burnetii vertebral osteomyelitis is rare and can occur by contiguous spread from an abdominal aneurysm or vascular Graft infection. It should be suspected in patients where pre-antibiotic cultures are negative with animal/ farming exposure.
Douglas R. Osmon - One of the best experts on this subject based on the ideXlab platform.
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Coxiella burnetii Multilevel Disk Space Infection, Epidural Abscess, and Vertebral Osteomyelitis Secondary to Contiguous Spread From Infected Abdominal Aortic Aneurysm or Graft: Report of 4 Cases Acquired in the US and Review of the Literature
Open Forum Infectious Diseases, 2017Co-Authors: Abinash Virk, Thomas C Bower, Manju Kalra, Maryam Mahmood, Douglas R. Osmon, Elie F. Berbari, Didier RaoultAbstract:Background. Chronic Coxiella burnetii infections such as vertebral osteomyelitis caused by contiguous spread from an infected abdominal Aortic Graft or aneurysm have been rarely reported and are associated with significant morbidity and mortality. Methods. We present the first four reported US acquired cases of Coxiella burnetii vertebral osteomyelitis caused by contiguous spread from an infected abdominal Aortic Graft or aneurysm. Results. Presenting symptoms included progressive back pain, malaise, and weight loss with recent or remote animal exposure. Typical imaging findings demonstrated a peri-Aortic collection with extension to the paraspinal muscles and vertebrae. Antibiotic regimens included doxycycline with either hydroxychloroquine or a quinolone for at least 2 years or as chronic suppression. Conclusions. C. burnetii vertebral osteomyelitis is rare and can occur by contiguous spread from an abdominal aneurysm or vascular Graft infection. It should be suspected in patients where pre-antibiotic cultures are negative with animal/ farming exposure.