SA JOURNAL OF DIABETES & VASCULAR DISEASE
REVIEW
VOLUME 11 NUMBER 1 • MARCH 2014
41
antimicrobial therapy as shown in Table 1. Patients diagnosed with
a PJI who have a well-fixed prosthesis without a sinus tract and
are within approximately 30 days of prosthesis implantation or less
than 3 weeks of onset of infectious symptoms should be considered
for a debridement and retention of the prosthesis. A one-stage or
direct exchange strategy or more commonly a two-stage exchange
strategy is considered in other patients who are medically able to
undergo multiple surgery.
45
In cases of spondylodiscitis indications for surgical intervention
include compression of neural elements, spinal instability due to
extensive bony destruction, severe kyphosis, or failure of conservative
management.
34,84
Anterior decompression and inter-body fusion
with posterior stabilisation has become the mainstay of surgical
management.
49
Epidural abscesses are usually managed by surgical
or percutaneous drainage, especially in thoracic and cervical spine
where the canal is narrow increasing the risk of rapid neurological
compromise.
46
Spinal cord compression is a surgical emergency.
S aureus
carriage
Carriers of
S aureus
who undergo medical procedures are at risk of
developing bacteremia.
2
There are reports showing that about 11%
of patients who were colonised with MRSA at hospital admission
developed nosocomial MRSA infection.
85,86
Although it was initially
believed that the highest risk of bacteraemia occurred during the
period immediately after colonisation, more recent studies have
suggested that the risk of infection and mortality may be higher
during the first year after colonisation (33%) then gradually falling
in subsequent years. The risk of infection and mortality may however
be completely unrelated to the duration of MRSA colonisation.
24,86,87
These data support the use of methods for decolonisation in
MRSA nasal carriers who are admitted to the hospital or who are
scheduled to undergo inpatient procedures.
86
However, the long-
term effects of MRSA decolonisation on the incidence of infection
remain unclear.
Conclusion
Patients with diabetes mellitus are a high-risk group for developing
invasive
S aureus
infection and associated complications. Detection
of
S aureus
in blood culture should trigger a chain of events
beginning with assessment of the patient to determine signs of
sepsis and to identify a potential deep-seated source, or metastatic
complications. The level of risk of a patient having MRSA infection
must be assessed. This assessment should not delay urgent
treatment with appropriate antibiotic therapy in a patient with
signs of sepsis and early surgical intervention. A recently published
algorithmdeveloped by the Scottish Antimicrobial Prescribing Group
may assist clinicians on the management of proven or suspected
S aureus
BSI in adults (Fig. 7).
88
Treatment should be guided by
local antibiotic policy alongside advice from microbiology and/or
infectious diseases consultants.
Declaration of conflicting interests
The author declares that there is no conflict of interest.
Funding
This research received no specific grant from any funding agency in
the public, commercial, or not-for-profit sectors.
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