Propionibacterium acnes infections after cranial neurosurgery.

BACKGROUND: Propionibacterium acnes (P. acnes) is a relatively avirulent organism that is part of the normal skin flora. Most patient isolates are considered contaminants but, in a small subset of patients, particularly in the post-neurosurgery setting, the organism can cause significant infections. We reviewed our experience with the occurrence and management of P. acnes infections after cranial neurosurgical procedures over a five-year period. METHODS: Patients with positive cultures for P. acnes between 1996 and 2001 were identified by review of the Saskatoon Health Region microbiology laboratory database. Of the 141 positive cultures, a review of hospital records identified six patients with P. acnes infections after neurosurgical procedures. A review of the literature related to P. acnes associated CNS infections was conducted. RESULTS: All patients had undergone a craniotomy or burrhole placement, and one patient had received prior radiotherapy. There were no P. acnes-related ventriculoperitoneal shunt infections. All patients presented with scalp swelling and three had purulent discharge. Symptoms occurred more than two months after the initial surgery in five of six patients, while one patient developed symptoms three years post-operatively. Management for all patients included removal of the craniotomy flap and treatment with parenteral antibiotics, followed in most cases by oral antibiotics. A good response without relapse of infection was seen in five patients; one patient had recurrent infection after cranioplasty. CONCLUSIONS: P. acnes is a rare but important cause of infection after craniotomy. Wound debridement, removal of the bone flap and adequate antibiotic coverage result in cure in the majority of patients.

Neuroprotection following fluid percussion brain trauma: a pilot study using quercetin.

Previously, we were able to demonstrate the neuroprotective effect of quercetin in an animal model of acute traumatic spinal cord injury. The objective of the present study was to determine whether any neuroprotective effect is seen when quercetin is administered in an animal model of traumatic brain injury. Twenty-six adult male Sprague-Dawley rats were submitted to moderate fluid percussion injury in the anterior midline position. Animals were divided into two experimental groups: one group received 25 mumol/kg quercetin starting 1 h after injury, while animals in the second group received saline vehicle (n = 13 per group). Eight animals were used as uninjured healthy controls. Eight animals in each experimental group were sacrificed at 24 h, while five animals per group were allowed to recover for 72 h following injury. Compound action potential amplitudes (CAPAs) were recorded on 400-microm vibrotome sections of the corpus callosum superfused with oxygenated artificial CSF (n = 3 per animal) in 20 experimental animals and five healthy controls. Three brains from animals in each experimental group and healthy controls were used for histological, immunocytochemical and biochemical analysis after sacrifice at 24 h. CAPAs in uninjured animals had a mean of 1.12 mV. This decreased to 0.55 mV in saline vehicle-treated injured animals by 24 h and changed little over the next 3 days. CAPAs were significantly better at 0.82 mV at 24 h and 0.76 mV at 3 days in quercetin-treated injured animals when compared to injured saline vehicle controls. Quercetin significantly prevented decrease of glutathione levels and decreased myeloperoxidase activity. We conclude that this dietary flavonoid has therapeutic potential following brain trauma.

Spinal subdural empyema after a dural tear. Case report.

Spinal subdural empyema is an exceptionally rare and serious condition. Immediate surgery with complete exposure and drainage of the abscess is generally recommended. The authors present a patient in whom a Staphylococcus aureus septicemia related to nosocomial pneumonia developed after a thoracic laminectomy. The surgery was further complicated by an unintended durotomy (dural tear). Ten days postoperatively, the patient experienced back pain and lower-extremity symptoms caused by a subdural empyema. Cultures from the wound also grew S. aureus. This represents the first case of spinal subdural empyema in which the spread of infection into the subdural space is believed to have been facilitated by a dural tear. The patient had a favorable outcome despite an initial delay in surgical intervention because of a pulmonary embolus.

Title comparison of primary and secondary spinal epidural abscesses: a retrospective analysis of 29 cases.

BACKGROUND: Spinal epidural abscesses (SEA) are uncommon. In certain regions their incidence is rising. Vague initial presentation may result in delayed diagnosis. Familiarity with SEA is imperative because if not treated expeditiously, they can have devastating neurologic sequelae. METHODS: A retrospective analysis using analysis of variance (ANOVA) was performed on patients diagnosed with SEA between 1980 through 2000. The patients were assigned to one of the two defined groups: primary (PSEA) consisted of SEA alone; secondary (SSEA) included SEAs with vertebral osteomyelitis. Both groups were compared for factors including survival, age, diagnostic accuracy, etiology, hospitalization, management, and outcome. RESULTS: Twenty-nine cases were identified. Four (23.7%) were PSEAs and 25 (86.2%) were SSEAs. Mean age (52.7 vs. 53.2 years) and mean duration of hospitalization (39.2 vs. 38.6 days) were comparable in both groups (p = 0.9). The admitting diagnosis was correct in 75% of PSEA and 20% of SSEA cases (p = 0.1). Staphylococcus aureus was present in 75% and 68%, respectively. In SSEA cases, 24% (n = 6) of the infections were consequent to spinal surgery. PSEA did not show a predilection for any level. Most (56%) cases of SSEA occurred at the lumbar levels. The entire PSEA group and 58.3% of the SSEA group underwent surgery (p = 0.06), 75% versus 40.9% had a good outcome for PSEA and SSEA, respectively. CONCLUSIONS: PSEAs are very rare. Both groups have similar characteristics. Staphylococci remain the predominant etiologic agent. PSEAs are treated by surgery; SSEAs are managed surgically or conservatively.