Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website http://www.jocmr.org

Original Article

Volume 6, Number 4, August 2014, pages 272-277

Vertebral Osteomyelitis: An Under-Recognized Infectious Complication in Patients on Home Parenteral Nutrition

Tables

Table 1. Infectious Complications in Patients on HPN
 
Type of infectionNb infection (nb patients)Nb infection per 1,000 CVC-day% Total complication
Urinary tract infection25 (10)0.74056.8
Pneumonia8 (6)0.23718.2
CVCS7 (5)0.20715.9
Secondary vertebral osteomyelitis3 (3)0.089
Sinusitis1 (1)0.0292.3
Dental abscess1 (1)0.0292.3
C. Difficile colitis1 (1)0.0292.3
Bacterial translocation with septicemia1 (1)0.0292.3
Total441.302100

 

Table 2. Characteristics of Individuals With VO
 
Patient 1Patient 2Patient 3
Age (years)425879
Main diseaseCrohn with short bowel syndrome (under 6-MP)Auto-immune enteropathy with malabsorption (under infliximab)Radiation enteritis
Duration of HPN (months)12119
Catheter characteristics
 TypePort-A-CathPort-A-CathHickmann
 SiteRight internal jugular veinRight subclavian veinRight internal jugular vein
 Duration (months)13119
Clinical criteria
 Back painYes (severe pain)Yes (slight)Yes (slight)
 Temperature > 38 °CYesYesYes
 Duration of symptoms1 month before consultation1 week before presentation2 weeks before presentation
Spine imaging studies
 Computed tomographyNot performedPossible Spondylodiscitis at L4-L5Not performed
 Magnetic resonance imagingSpondylodiscitis at D7-D8 and D9-D10Possible Spondylodiscitis at L4-L5Sondylodiscitis at L3-L4
Additional imaging
 X-rayOsteopenia, compression fractures of D7 and D8Osteopenia, no spondylodiscitisOsteopenia, no spondylodiscitis
 Gallium scanningSpondylodiscitis at D9-D10Spondylodiscitis at L4-L5Spondylodiscitis at L4
 Cardiac ultrasoundNo endocarditisNot performedNo endocarditis
Microbiological criteria
 Peripheral vein culturesStaphylococcus lugdunensisStaphylococcus epidermidisStaphylococcus epidermidis
 Central catheter culturesSame as peripheral veinNot performedSame as peripheral vein cultures
Treatment
 IV antibiotics for 6 weeksCefazolinVancomycineVancomycine
 Central catheter replacementYesYesYes