the Right Specialists for Bacteremia and Spinal Abscess

For bacteremia and spinal abscess, you should consult an infectious disease specialist and a neurosurgeon?

Hello, my father is 60 years old.
He was previously hospitalized due to poorly controlled diabetes and was found to have Salmonella in his bloodstream, for which he received treatment with first and second-line antibiotics.
During this time, he underwent surgery for a spinal abscess, but postoperatively, he experienced spinal collapse and more abscesses were discovered, necessitating further debridement.
Currently, due to the bacterial issue, he cannot have metal rods inserted and has been lying flat in bed for over a month while receiving antibiotic treatment, but the bacteria remain present in his blood.
We are concerned about delaying treatment and are considering transferring him to another hospital, but we are unsure which specialty he should see.
Additionally, my father has not eaten regular meals for over a year and only drinks nutritional supplements, consuming up to six bottles a day since being hospitalized.
His chromium niacinate intake has reached 600 μg, while the recommended daily amount is only 20-200 μg.
Is this really without side effects? Thank you.

Niming, 20~29 year old female. Ask Date: 2017/07/12

Dr. Liao Zhongxin reply Internal Medicine

Dear readers,
Regarding chromium niacin at levels up to 600μg, the side effects of excessive intake are as follows:
1.
Skin flushing and itching.

2.
Elevated serum uric acid levels.

3.
Impaired glucose tolerance.

4.
Liver damage.
Regarding the presence of Salmonella in the blood, the responses are as follows:
1.
Individuals with poorly controlled diabetes who frequently consume undercooked egg products are at higher risk for Salmonella infection.
2.
If Salmonella infection also affects the spine, surgical debridement and antibiotic treatment are necessary.
3.
If Salmonella spreads distally or persists within the bloodstream without resolution, bacteremia will continue.
4.
If the patient is already in a regional or higher-level hospital, there should be sufficient manpower (orthopedics, neurosurgery, cardiovascular surgery, infectious disease specialists, etc.) and medications (advanced antibiotics) available to manage this complex case.
Thank you!

Reply Date: 2017/07/12

More Info

When dealing with a complex case of bacteremia and spinal abscess, especially in a patient with underlying conditions such as diabetes, it is crucial to have a multidisciplinary approach. Your father's situation, involving Salmonella bacteremia and subsequent spinal abscess surgeries, requires careful management and the involvement of several specialists.

Recommended Specialists
1. Infectious Disease Specialist: Given the persistent bacteremia, an infectious disease (ID) specialist is essential. They can provide expertise in managing complex infections, especially those that are resistant to standard treatments. They will assess the appropriateness of the antibiotics being used and may suggest alternative therapies or combinations to effectively target the bacteria.

2. Neurosurgeon or Orthopedic Spine Surgeon: Since your father has undergone surgery for spinal abscesses, a neurosurgeon or an orthopedic spine surgeon specializing in spinal conditions should be involved. They can evaluate the structural integrity of the spine post-surgery and determine if further surgical intervention is necessary or if conservative management is appropriate.

3. Endocrinologist: Given your father's diabetes, an endocrinologist can help manage his blood sugar levels, which is crucial for recovery from infections and surgeries. Poorly controlled diabetes can significantly impair healing and increase the risk of complications.

4. Nutritionist or Dietitian: Since your father has not been eating solid foods and relies heavily on nutritional supplements, a nutritionist can help develop a balanced diet plan that meets his needs. Proper nutrition is vital for recovery, especially when dealing with infections and surgical recovery.

5. Physical Therapist: Once your father's condition stabilizes, a physical therapist can assist in rehabilitation, focusing on regaining strength and mobility, which is essential after prolonged bed rest.

Concerns Regarding Nutritional Supplements
Regarding the high intake of niacin (nicotinic acid) at 600 μg daily, it is important to monitor this closely. While niacin is essential for metabolic processes, excessive intake can lead to side effects such as flushing, gastrointestinal issues, and liver toxicity, particularly at higher doses. The recommended daily allowance (RDA) for niacin varies, but for adults, it typically ranges from 14 to 16 mg (14,000 to 16,000 μg) per day. Therefore, if your father is consuming 600 μg, it is within a safe range, but it is essential to ensure that he is not exceeding the upper limits, especially if he is taking additional supplements or medications that may contain niacin.

Next Steps
1. Transfer to a Specialized Facility: If your current hospital does not have the necessary specialists, consider transferring your father to a facility with a strong infectious disease department and a spinal surgery unit. This will ensure he receives comprehensive care tailored to his complex needs.

2. Regular Monitoring: Continuous monitoring of his blood cultures and clinical status is essential. If bacteremia persists, further imaging studies may be necessary to identify any hidden sources of infection.

3. Holistic Approach: Engage all specialists in a case conference to discuss your father's treatment plan. This collaborative approach can help address all aspects of his health, from infection control to nutritional support and rehabilitation.

In conclusion, your father's case is multifaceted, requiring a coordinated effort from various specialists to ensure the best possible outcome. Regular communication with the healthcare team and active involvement in his care plan will be vital as you navigate this challenging situation.

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