702. No relapse of brucellar vertebral osteomyelitis after  long-term triple antibiotics combination. Evaluation of treatment modalities and final outcome
Session: Poster Abstract Session: Skin, Soft Tissue and Joint Infections
Friday, October 21, 2011
Room: Poster Hall B1
Background:  Vertebral brucellar spondylitis is a significant complication of brucellosis bearing diagnostic and therapeutic challenges.  Treatment modalities  of prospectively collected data from a  University  Department were analyzed as optimal regimen and treatment duration has not been established yet.

Methods: Demographics, comorbidities, rural residency, risk factors, duration of the disease, prior therapies, complications and relapses were assessed. Safety and efficacy of two treatment modalities, the backbone treatment (doxycycline plus rifampicin) plus either cotrimoxazole (DRC) or ofloxacin(DRO) as a third therapeutic agent, were analyzed. Clinical, laboratory and MRI imaging criteria defined the end of therapy. A regression analysis of factors influencing the disease’s outcome was preformed. Standard clinical, laboratory microbiology and imaging case definition were applied.

Results:  Eligible patients (n=31) were male (58%), elderly with a median age + IQR (25-75) of  63(51.5- 68) years with comorbidities (58%), risk factors for brucellosis (71%)  and rural residency (80.6%). Median time from the onset of symptoms was 12 months (range 4-20) with a 48.3% rate of previous unsuccessful treatment. Spinal pain was initially underestimated in 53% of patients. Paravertebral lesions (n=12) were significantly associated with residual pain (OR = 20.3, CI 95% 1.9-218.2, p=0.01) in a  post-treatment follow-up of median+IQR(25-75) of 52(21.2-84) months.

No difference regarding demographics, clinical features, treatment duration [median+ IQR(25-75) 8(6-12) months] and final outcome was found between DRC and DRO group. Reversible adverse events were detected in 6 patients. No surgical intervention was needed.

Conclusion: We  recommend the triple combination  ( DRC or DRO)  for a prolonged period ( at least 3 months) for cases of  initial treatment failure   or relapsing vertebral brucellosis. Paravertebral lesions even not requiring surgery are associated with residual  back pain  despite   successful treatment of brucellosis.


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Efthymia Giannitsioti, MD1, Antonios Papadopoulos, MD, ID2, Paraskevas Nikou, MD3, Sofia Athanasia, MD4, Alexandros Kelekis3, Vissaria Sakka, MD5, Androniki Drakou3, Archontoula Fragou3, George Koukos2, Stavroula Kanellaki2, Kyriaki Kanellakopoulou, MD3 and Helen Giamarellou3, (1)University General Hospital Attikon, Athens Medical School, Chaidari, Greece, (2)University General Hospital ATTIKON, Athens, Greece, (3)University General Hospital Attikon, Athens Medical School, Athens, Greece, (4)University General Hospital Attikon, Chaidari, Greece, (5)University General Hospital Attikon, Haidari, Greece


E. Giannitsioti, None

A. Papadopoulos, None

P. Nikou, None

S. Athanasia, None

A. Kelekis, None

V. Sakka, None

A. Drakou, None

A. Fragou, None

G. Koukos, None

S. Kanellaki, None

K. Kanellakopoulou, None

H. Giamarellou, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.