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Antimicrobial and Medical Therapy

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Cranial Osteomyelitis

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Abstract

Medical therapy, especially antimicrobial therapy, is generally concomitant to surgical procedure. The antimicrobial agents require in particular a good penetration into the cranial bone and the surrounded anatomic structures. As in other sites of the body, the duration of treatment of cranial osteomyelitis is not standardized. It mainly depends on the duration and extent of the infection, the rapidity of the clinical and laboratory response to treatment, and the quality of the initial surgical debridement. However, it is important to know that insufficient treatment duration leads to recurrence and increase the spread of antibiotic-resistant pathogens. The increasing development of antibiotic resistance will probably make conservative treatment even less successful than it is now. Additionally, various concomitant therapies may be added depending on potential comorbidities, the location of the cranial suppuration, and severity of the disease. Also, the treating physician should consider host compromise and treat any compromising condition, when feasible, concomitantly with the infection. This chapter summarizes the available guidelines on the medical management of cranial osteomyelitis including choice of antimicrobial drugs, duration, and monitoring response to treatment. Recommendations for supportive therapies are also included.

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Abbreviations

CSF:

Cerebrospinal fluid

MRSA:

Methicillin-resistant Staphylococcus aureus

VRSA:

Vancomycin-resistant Staphylococcus aureus

References

  1. Benak MA, Kent 3rd RB. Simultaneous placement of long-term central venous catheters and surgical debridement for treatment of osteomyelitis. Am Surg. 2001;67(8):790–2.

    CAS  PubMed  Google Scholar 

  2. Schmid MW. Risks and complications of peripherally and centrally inserted intravenous catheters. Crit Care Nurs Clin North Am. 2000;12(2):165–74.

    CAS  PubMed  Google Scholar 

  3. Ruebner R, Keren R, Coffin S, Chu J, Horn D, Zaoutis TE. Complications of central venous catheters used for the treatment of acute hematogenous osteomyelitis. Pediatrics. 2006;117(4):1210–5.

    Article  PubMed  Google Scholar 

  4. Akova M, Akalìn HE, Korten V, Ozgen T, Erbengi A. Treatment of intracranial abscesses: experience with sulbactam/ampicillin. J Chemother. 1993;5(3):181–5.

    Article  CAS  PubMed  Google Scholar 

  5. Savitz MH, Dickinson T. Drug therapy for intracranial suppuration. Am Fam Physician. 1988;37(2):341–4.

    CAS  PubMed  Google Scholar 

  6. Tomovic S, Friedel ME, Liu JK, Eloy JA. Community-acquired methicillin-resistant Staphylococcus aureus skull base osteomyelitis with occipital condylar cerebrospinal fluid leak in an immunocompetent patient. Laryngoscope. 2012;122(5):977–81. doi:10.1002/lary.23253.

    Article  PubMed  Google Scholar 

  7. Menif K, Bouziri A, Borgi A, Khaldi A, Ben Hassine L, Ben JN. Community acquired methicillin-resistant Staphylococcus aureus preseptal cellulitis complicated by zygomatic osteomylitis, cavernous sinus thrombosis and meningitis in a healthy child. Fetal Pediatr Pathol. 2011;30(4):252–6. doi:10.3109/15513815.2011.555810.

    Article  PubMed  Google Scholar 

  8. Laurens MB, Becker RM, Johnson JK, Wolf JS, Kotloff KL. MRSA with progression from otitis media and sphenoid sinusitis to clival osteomyelitis, pachymeningitis and abducens nerve palsy in an immunocompetent 10-year-old patient. Int J Pediatr Otorhinolaryngol. 2008;72(7):945–51. doi:10.1016/j.ijporl.2008.02.025.

    Article  PubMed  Google Scholar 

  9. Nam JR, Kim MS, Lee CH, Whang DH. Linezolid treatment for osteomyelitis due to Staphylococcus epidermidis with reduced vancomycin susceptibility. J Korean Neurosurg Soc. 2008;43(6):307–10. doi:10.3340/jkns.2008.43.6.307.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Rayner CR, Baddour LM, Birmingham MC, Norden C, Meagher AK, Schentag JJ. Linezolid in the treatment of osteomyelitis: results of compassionate use experience. Infection. 2004;32(1):8–14.

    Article  CAS  PubMed  Google Scholar 

  11. Garazzino S, Tovo PA. Clinical experience with linezolid in infants and children. J Antimicrob Chemother. 2011;66 Suppl 4:iv23–41. doi:10.1093/jac/dkr074.

    CAS  PubMed  Google Scholar 

  12. Osborn MK, Steinberg JP. Subdural empyema and other suppurative complications of paranasal sinusitis. Lancet Infect Dis. 2007;7(1):62–7.

    Article  PubMed  Google Scholar 

  13. Hall WA, Truwit CL. The surgical management of infections involving the cerebrum. Neurosurgery. 2008;62 Suppl 2:519–30. doi:10.1227/01.neu.0000316255.36726.5b.

    PubMed  Google Scholar 

  14. Heth JA. Neurosurgical aspects of central nervous system infections. Neuroimaging Clin N Am. 2012;22(4):791–9. doi:10.1016/j.nic.2012.05.005.

    Article  PubMed  Google Scholar 

  15. Tunkel AR. Brain abscess. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. 6th ed. New York: Churchill Livingstone; 2005.

    Google Scholar 

  16. Uçkay I, Jugun K, Gamulin A, Wagener J, Hoffmeyer P, Lew D. Chronic osteomyelitis. Curr Infect Dis Rep. 2012;14(5):566–75. doi:10.1007/s11908-012-0286-0.

    Article  PubMed  Google Scholar 

  17. Parize P, Chandesris MO, Lanternier F, Poirée S, Viard JP, Bienvenu B, Mimoun M, Méchai F, Mamzer MF, Herman P, Bougnoux ME, Lecuit M, Lortholary O. Antifungal therapy of Aspergillus invasive otitis externa: efficacy of voriconazole and review. Antimicrob Agents Chemother. 2009;53(3):1048–53. doi:10.1128/AAC.01220-08.

    Article  CAS  PubMed  Google Scholar 

  18. Lass-Flörl C. Triazole antifungal agents in invasive fungal infections: a comparative review. Drugs. 2011;71(18):2405–19. doi:10.2165/11596540-000000000-00000.

    Article  PubMed  Google Scholar 

  19. Lodge BA, Ashley ED, Steele MP, Perfect JR. Aspergillus fumigatus empyema, arthritis, and calcaneal osteomyelitis in a lung transplant patient successfully treated with posaconazole. J Clin Microbiol. 2004;42:1376–8.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ramdurg SR, Gupta DK, Suri A, Sharma BS, Mahapatra AK. Calvarial tuberculosis: uncommon manifestation of common disease—a series of 21 cases. Br J Neurosurg. 2010;24(5):572–7. doi:10.3109/02688697.2010.495166.

    Article  PubMed  Google Scholar 

  21. Elopre L, Morell V, Bosshardt C, Geisler WM. A case of syphilitic osteitis in a patient with HIV infection. Int J STD AIDS. 2014;25(10):765–7. doi:10.1177/0956462414522031.

    Article  PubMed  Google Scholar 

  22. Eckert J, Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev. 2004;17(1):107–35.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Spielmann PM, Yu R, Neeff M. Skull base osteomyelitis: current microbiology and management. J Laryngol Otol. 2013;127 Suppl 1:S8–12. doi:10.1017/S0022215112002356.

    Article  PubMed  Google Scholar 

  24. Cavel O, Fliss DM, Segev Y, Zik D, Khafif A, Landsberg R. The role of the otorhinolaryngologist in the management of central skull base osteomyelitis. Am J Rhinol. 2007;21(3):281–5.

    Article  PubMed  Google Scholar 

  25. Mani N, Sudhoff H, Rajagopal S, Moffat D, Axon PR. Cranial nerve involvement in malignant external otitis: implications for clinical outcome. Laryngoscope. 2007;117(5):907–10.

    Article  PubMed  Google Scholar 

  26. Lee SJ, Weon YC, Cha HJ, Kim SY, Seo KW, Jegal Y, Ahn JJ, Ra SW. A case of atypical skull base osteomyelitis with septic pulmonary embolism. J Korean Med Sci. 2011;26(7):962–5. doi:10.3346/jkms.2011.26.7.962.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Djalilian HR, Shamloo B, Thakkar KH, Najme-Rahim M. Treatment of culture-negative skull base osteomyelitis. Otol Neurotol. 2006;27(2):250–5.

    Article  PubMed  Google Scholar 

  28. Bernstein JM, Holland NJ, Porter GC, Maw AR. Resistance of pseudomonas to ciprofloxacin: implications for the treatment of malignant otitis externa. J Laryngol Otol. 2007;121(2):118–23.

    Article  CAS  PubMed  Google Scholar 

  29. Le Clerc N, Verillaud B, Duet M, Guichard JP, Herman P, Kania R. Skull base osteomyelitis: incidence of resistance, morbidity, and treatment strategy. Laryngoscope. 2014;124(9):2013–6. doi:10.1002/lary.24726.

    Article  PubMed  Google Scholar 

  30. Patmore H, Jebreel A, Uppal S, Raine CH, McWhinney P. Skull base infection presenting with multiple lower cranial nerve palsies. Am J Otolaryngol. 2010;31(5):376–80. doi:10.1016/j.amjoto.2009.04.001.

    Article  PubMed  Google Scholar 

  31. Johnson AK, Batra PS. Central skull base osteomyelitis: an emerging clinical entity. Laryngoscope. 2014;124(5):1083–7. doi:10.1002/lary.24440.

    Article  PubMed  Google Scholar 

  32. Yamazaki H, Kikuchi M, Shinohara S, Naito Y, Fujiwara K, Kanazawa Y, Tona R. Intra-arterial administration of antibiotics for refractory skull base osteomyelitis. Auris Nasus Larynx. 2014;41(4):380–3. doi:10.1016/j.anl.2013.12.003.

    Article  PubMed  Google Scholar 

  33. Moser R, Schweintzger G, Uggowitzer M, Urban C, Stammberger H, Eder H, Kerbl R. Recurrent Pott’s puffy tumor—atypical presentation of a rare disorder. Wien Klin Wochenschr. 2009;121(21–22):719–22. doi:10.1007/s00508-009-1268-6.

    Article  PubMed  Google Scholar 

  34. Lew DP, Waldvogel FA. Osteomyelitis. N Engl J Med. 1997;336(14):999–1007.

    Article  CAS  PubMed  Google Scholar 

  35. Lew DP, Waldvogel FA. Osteomyelitis. Lancet. 2004;364(9431):369–79.

    Article  CAS  PubMed  Google Scholar 

  36. Ng J, Connolly DJ, Rittey CD, Mordekar SR. Skull base osteomyelitis leading to lateral medullary syndrome in a child. Eur J Paediatr Neurol. 2007;11(2):111–4.

    Article  PubMed  Google Scholar 

  37. Lee S, Hooper R, Fuller A, Turlakow A, Cousins V, Nouraei R. Otogenic cranial base osteomyelitis: a proposed prognosis-based system for disease classification. Otol Neurotol. 2008;29(5):666–72. doi:10.1097/MAO.0b013e318179972f.

    Article  CAS  PubMed  Google Scholar 

  38. Dawar P, Satyarthee GD, Sharma BS. Total resolution of large scalp swelling due to calvarial tuberculosis with medical management only: case report and review of the literature. Turk Neurosurg. 2015;25(2):313–6. doi:10.5137/1019-5149.JTN.7937-13.1.

    PubMed  Google Scholar 

  39. Akhaddar A, Elouennass M, Baallal H, Boucetta M. Focal intracranial infections due to Actinomyces species in immunocompetent patients: diagnostic and therapeutic challenges. World Neurosurg. 2010;74(2–3):346–50. doi:10.1016/j.wneu.2010.05.029.

    Article  PubMed  Google Scholar 

  40. Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Segal BH, Steinbach WJ, Stevens DA, van Burik JA, Wingard JR, Patterson TF, Infectious Diseases Society of America. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2008;46(3):327–60. doi:10.1086/525258.

    Article  CAS  PubMed  Google Scholar 

  41. Seabold JE, Simonson TM, Weber PC, Thompson BH, Harris KG, Rezai K, Madsen MT, Hoffman HT. Cranial osteomyelitis: diagnosis and follow-up with In-111 white blood cell and Tc-99m methylene diphosphonate bone SPECT, CT, and MR imaging. Radiology. 1995;196(3):779–88.

    Article  CAS  PubMed  Google Scholar 

  42. Epstein JS, Ganz WI, Lizak M, Grobman L, Goodwin WJ, Dewanjee MK. Indium 111-labeled leukocyte scintigraphy in evaluating head and neck infections. Ann Otol Rhinol Laryngol. 1992;101(12):961–8.

    CAS  PubMed  Google Scholar 

  43. Parker KM, Nicholson JK, Cezayirli RC, Biggs PJ. Aspergillosis of the sphenoid sinus: presentation as a pituitary mass and postoperative gallium-67 imaging. Surg Neurol. 1996;45(4):354–8.

    Article  CAS  PubMed  Google Scholar 

  44. Yocum J, Seligson D. Blastomycosis of the knee and skull after arthroscopy. Am J Sports Med. 1991;19(6):670–2.

    Article  CAS  PubMed  Google Scholar 

  45. Wilkinson EP, Robinson RA, Trask DK. Skull base thrombotic mycosis. Ear Nose Throat J. 2007;86(3):137.

    PubMed  Google Scholar 

  46. Mukherjee KK, Kaushik R, Nada R, Khosla VK, Khandelwal N, Kak VK. Calvarial tuberculosis. Surg Neurol. 2002;57(3):195–202.

    Article  CAS  PubMed  Google Scholar 

  47. Peer Mohamed B, Carr L. Neurological complications in two children with Lemierre syndrome. Dev Med Child Neurol. 2010;52(8):779–81. doi:10.1111/j.1469-8749.2010.03718.x.

    Article  PubMed  Google Scholar 

  48. Kao CH, Wang SJ. Spread of infectious complications of odontogenic abscess detected by technetium-99m-HMPAO-labeled WBC scan of occult sepsis in the intensive care unit. J Nucl Med. 1992;33(2):254–5.

    CAS  PubMed  Google Scholar 

  49. Nakwan N, Nakwan N, Wannaro J, Dissaneevate P, Kritsaneepaiboon S, Chokephaibulkit K. Septicemia, meningitis, and skull osteomyelitis complicating infected cephalhematoma caused by ESBL-producing Escherichia coli. Southeast Asian J Trop Med Public Health. 2011;42(1):148–51.

    PubMed  Google Scholar 

  50. He J, Lam JC, Adlan T. Clival osteomyelitis and hypoglossal nerve palsy-rare complications of Lemierre’s syndrome. BMJ Case Rep. 2015;2015:pii: bcr2015209777. doi:10.1136/bcr-2015-209777.

    Article  Google Scholar 

  51. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb SA, Beale RJ, Vincent JL, Moreno R, Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580–637. doi:10.1097/CCM.0b013e31827e83af.

    Article  PubMed  Google Scholar 

  52. Pradilla G, Ardila GP, Hsu W, Rigamonti D. Epidural abscesses of the CNS. Lancet Neurol. 2009;8(3):292–300. doi:10.1016/S1474-4422(09)70044-4.

    Article  PubMed  Google Scholar 

  53. Bhatia K, Jones NS. Septic cavernous sinus thrombosis secondary to sinusitis: are anticoagulants indicated? A review of the literature. J Laryngol Otol. 2002;116(9):667–76.

    Article  CAS  PubMed  Google Scholar 

  54. Bousser MG. Cerebral venous thrombosis: nothing, heparin, or local thrombolysis? Stroke. 1999;30(3):481–3.

    Article  CAS  PubMed  Google Scholar 

  55. Stam J. Thrombosis of the cerebral veins and sinuses. N Engl J Med. 2005;352(17):1791–8.

    Article  CAS  PubMed  Google Scholar 

  56. Masuhr F, Mehraein S, Einhaupl K. Cerebral venous and sinus thrombosis. J Neurol. 2004;251(1):11–23.

    Article  CAS  PubMed  Google Scholar 

  57. Crawford SC, Digre KB, Palmer CA, Bell DA, Osborn AG. Thrombosis of the deepvenous drainage of the brain in adults. Analysis of seven cases with review of the literature. Arch Neurol. 1995;52(11):1101–8.

    Article  CAS  PubMed  Google Scholar 

  58. Bentham JR, Pollard AJ, Milford CA, Anslow P, Pike MG. Cerebral infarct and meningitis secondary to Lemierre’s syndrome. Pediatr Neurol. 2004;30(4):281–3.

    Article  PubMed  Google Scholar 

  59. Huang KL, Lu CS. Skull base osteomyelitis presenting as Villaret’s syndrome. Acta Neurol Taiwan. 2006;15(4):255–8.

    PubMed  Google Scholar 

  60. Jones TH, Bergvall V, Bradshaw JP. Carotid-artery stenoses and thrombosis secondary to cavernous sinus thromboses in fusobacterium-necrophorum meningitis. Postgrad Med J. 1990;66(779):747–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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  1. Department of Neurosurgery Avicenne Military Hospital of Marrakech, University of Mohammed V in Rabat, Marrakech, Morocco

    Ali Akhaddar

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Akhaddar, A. (2016). Antimicrobial and Medical Therapy. In: Cranial Osteomyelitis. Springer, Cham. https://doi.org/10.1007/978-3-319-30268-3_11

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