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Suggest Treatment For A Surgical Site Infection With Mycobacterium Boletti When Diagnosed With Osteonecrosis And Osteomyelitis

Posted on Tue, 6 Jun 2023

Question: I'm going to try to make this as brief as possible period in March 2017 I had a fusion of my lumbar spine L5 to S1. it was complicated by a surgical site infection with mycobacterium boletti. I was also diagnosed with osteonecrosis and osteomyelitis. since then I've had six surgeries with wound vacs. my latest surgery was in January 2018. I had removal of the pedicle screws a laminectomy of L4 L5 and a complex wound closure. at that time I did have a wound vac and the wound was quite deep it was down to the bone. When the wound closure was done however it was much shallower but it was so complex because it was still wide but not as deep. unfortunately due to insurance issues the wound care physician that I was saying will not see me because he said I am out of Global Network because his loss surgery was over 90 days ago. The surgeon that performed the surgery was my neurosurgeon I am writing to you because I am concerned about a the way that my back is looking I'm going to attach a picture of my back now this has happened overnight. Prior to that my back incision was a little red and it has been having difficulty healing. But now it is much more red and quite painful I cannot stand up straight. I would just like an opinion on what it looks like what I should do and what to go from here thank you.

Answered by Dr. Saddiq Ulabidin (10 hours later)

Brief Answer:
May need surgical wound review and repeat cultures

Detailed Answer:

Hi,

Based on the history you have shared, the signs and the picture in your other queries clearly provoke a need for the work up of wound infection and wound cultures need to be repeated to confirm whether any other opportunistic organism has colonized the area or not. Local Condition also asks need to be worked up for other factors of impaired wound healing as it has taken unduly longer than usual in your case.

A local wound care with topical antiseptic solutions and oral antibiotics may be started prophylactically including either Ciprofloxacin along with Metronidazole for broader wound coverage and for gram positive bacteria either penicillin or Linezolid course may need to be repeated.

If oral antibiotics fail or cultures reports guide so then intravenous broad spectrum antibiotics and wound drainage and exploration might be needed. For temperature spikes OTC analgesics like acetaminophen may help. Taking supplements for calcium, iron, folic acid, vitamin C and zinc can help with better wound recovery.

Wishing you a speedy recovery. Hope this has answered your query. If you have any more questions please feel free to ask.

Regards,
Dr. Saddiq Ulabidin
General & Family Physician

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Saddiq Ulabidin (2 days later)

Thank you for your response. I did end up going to the ED for excruciating lumbar pain, weakness and falls. initial ct showed abscesses so I was admitted. an MRI was done and this is the report what is your interpretation of It? I will not see my neurosurgeon til Wednesday. other associates are on call til then.

Answered by Dr. Saddiq Ulabidin (8 hours later)

Brief Answer:
Can still suggest infection pockets

Detailed Answer:

Hi,

It's good that you got admitted for better care as things weren't looking to be controlled just by oral medications. The fluid pockets seen in the MRI can be infection collection and the drainage with radiological guidance may be done by interventional radiologist or neurosurgeon. The fluid if drained can be sent for cultures and sensitivity testing to isolate the exact causative organisms and antibiotics it may be sensitive to.

Hope I have answered your query.

Regards,
Dr. Saddiq Ulabidin
General & Family Physician

Above answer was peer-reviewed by : Dr. Remy Koshy