Table 1.
Overview of cases
| Patient no. | Sex/age | Symptoms on presentation | Predisposing condition | Site of infection | Diagnosis | Organism | Inflammatory markers on admission (white blood cells: WBC, C-reactive protein: CRP) | Surgery | Duration of admission (days) |
|---|---|---|---|---|---|---|---|---|---|
| 1 | F/76 | Back pain Fever Lower limb weakness |
Malignancy | L3/L4 | ≥2 +ve blood cultures | E. coli | WBC: 7.7 CRP: 78 |
No | 76 |
| 2 | M/81 | Lower limb weakness Fever |
Diabetes malignancy | L5/S1 | ≥2 +ve blood cultures | P. aeruginosa | WBC: 19.14 CRP: 183 |
No | 49 |
| 3 | M/68 | Back pain Lower limb weakness Fever Rigors Weight loss |
Malignancy Immunosuppresion |
L3/L4 | 1 +ve blood culture | H. influenzae | WBC: 5.38 CRP: 369 |
No | 23 |
| 4 | M/73 | Back pain Rigors |
Malignancy Immunosuppresion |
L5/S1 | Spinal biopsy + 1 +ve blood culture | P. aeruginosa | WBC: 8.5 CRP: 353 |
No | 12 |
| 5 | M/73 | Back pain Lower limb weakness |
Diabetes | L3/L4 | Spinal biopsy + ≥ 2 +ve blood cultures | K. pneumoniae | WBC: 9.0 CRP: 299 |
Yes | 156 |
| 6 | F/86 | Back pain Fever Rigors |
Malignancy | L3/L4 | Intraoperative sample | P. aeruginosa | WBC: 7.3 CRP: 147 |
Yes | 76 |
| 7 | M/78 | Back pain Fever Rigors Lower limb weakness |
Diabetes Malignancy Long-term uninary catheter |
T9/T10 | Intraoperative tissue | E. coli | WBC: 6.78 CRP: 149 |
Yes | 84 |
| 8 | M/78 | Back pain Fever Rigors Confusion Weight loss |
Malignancy EVAR |
T10/T11 & L4/5 | ≥2 +ve blood cultures | E. coli | WBC: 10.66 CRP: 121 |
No | 26 |
| 9 | M/88 | Back pain Fever Rigors Weight loss |
Long-term urinary catheter Malignancy |
T10/T11 | ≥2 +ve blood cultures | E. cloacae | WBC: 10.06 CRP: 227 |
No | 44 |
| 10 | F/64 | Back pain Fever |
Diabetes Pylonephritis 6/52 prior |
T8/T9 | Intraoperative sample | E. coli | WBC: 8.77 CRP: 9.1 |
Yes | 24 |
| Patient no. | Sex/age | Length of time before MRI performed (days) | Length of time to from admission first +ve micro sample (days) | Length of time from admission to directed antibiotics (days) | Length of time from MRI to directed antibiotics commenced (days) | Directed antibiotics and duration (weeks) | Outcome | Comment: Delay in directed antibiotics | |
|---|---|---|---|---|---|---|---|---|---|
| 1 | F/76 | 25 | 1 | 51 | 26 | Ciprofloxacin oral (10) | Resolved:initial failure of therapy | ||
| 2 | M/81 | 9 | 2 | 2 | −7* | Ciprofloxacin oral (8) | Resolved | ||
| 3 | M/68 | 11 | 1 | 3 | −8* | Amoxicillin IV (2) Ciprofloxacin oral (4) |
Resolved | ||
| 4 | M/73 | 28 | 0 | 6 | −22* | Ciprofloxacin oral (8) | Resolved | ||
| 5 | M/73 | 66 | 1 | 62 | −4* | Meropenum IV (7) | Resolved:initial failure of therapy | ||
| 6 | F/86 | 5 | 17 | 19 | 14 | Tazocin IV (5) and Ciprofloxacin PO (2) | Resolved | 12 day delay in surgery from positive MRI. Hence delay in microbiological diagnosis | |
| 7 | M/78 | 3 | 3 | 7 | 4 | Amox and Gent IV (2) and Amox PO (4) | Resolved | ||
| 8 | M/78 | 55 | 1 | 2 | 2 | IV Amox and Gent (2) patient SD after IV ceftriaxone (4) in the community | Resolved | ||
| 9 | M/88 | 4 | 12 | 19 | 15 | Meropenum IV (3) and Ciprofloxacin (LT) | Failure to therapy: Patient refused surgical intervention | Patient commenced on empirical treatment prior to blood cultures, hence delay in microbiological diagnosis | |
| 10 | F/64 | 6 days prior to admission | 3 | 189 | 195 | Meropenum (6) | Failure of therapy - Patient died |
Delay in microbiological diagnosis, after initial empirical treatment |
* already commenced on definitive antibiotics before MRI