Letters to the Editor The role of hypogammaglobulinemia in patients with severe sepsis and septic shock as well as in some patients with SIRS of non-infectious etiology clearly warrants future controlled clinical trials with IVIG use in these patient populations.

References 1. Kang CI, Song JH, Chung DR, Peck KR, Ko KS, Yeom JS, Korean Network for Study of Infectious Diseases (KONSID), et al. Risk factors and pathogenic significance of severe sepsis and septic shock in 2286 patients with gram-negative bacteremia. J Infect 2011 Jan;62(1):26e33. 2. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med 2003;4:530e8. 3. Stiehm ER, Ochs HD, Winkelstein JA. Immunologic disorders in infants & children. Philadelphia, PA: Elsevier Saunders; 2004. 4. Taccone FS, Stordeur P, De Backer D, Creteur J, Vincent J-L. Gamma globulin levels in patients with community acquired septic shock. Shock 2009;32:379e85. 5. Myrianthefs PM, Boutzouka A, Baltopoulos GJ. g-globulin levels in patients with community-acquired septic shock. Shock 2010; 33:556e7. 6. Laupland KB, Kirkpatrick AW, Delaney A. Polyclonal intravenous immunoglobulin for the treatment of severe sepsis and septic shock in critically ill adults: a systematic review and meta-analysis. Crit Care Med 2007;35:2686e92. 7. Turgeon AF, Hutton B, Fergusson DA, McIntyre L, Tinmouth AA, Cameron DW, et al. Meta-analysis: intravenous immunoglobulin in critically ill adult patients with sepsis. Ann Intern Med 2007; 146:193e201. 8. Berlot G, Vassallo MC, Busetto N, Bianchi M, Zornada F, Rosato I, et al. Relationship between the timing of administration of IgM and IgA enriched immunoglobulins in patients with severe sepsis and septic shock and the outcome: a retrospective analysis. J Crit Care 2012;27:167e71. 9. Rankin JS, Oguntolu O, Binford RS, Trochtenberg DS, Muhlbaier LH, Stratton CW. Management of immune dysfunction after adult cardiac surgery. J Thorac Cardiovasc Surg 2011;142:575e80. 10. Raithatha AH, Bryden DC. Use of intravenous immunoglobulin therapy in the treatment of septic shock, in particular severe invasive group A streptococcal disease. Indian J Crit Care Med 2012;16:37e40.

M. Prucha Department of Clinical Biochemistry, Hematology and Immunology, Na Homolce Hospital, 150 30 Prague, Czech Republic *Corresponding author. Tel.: þ420 257273150; fax: þ420 257272965.

R. Zazula Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and Thomayer University Hospital, 140 00 Prague, Czech Republic I. Herold Department of Intensive Care Medicine, Klaudian’s Hospital, 293 00 Mlada Boleslav, Czech Republic M. Dostal Institute of Experimental Medicine, Academy of Science, 140 00 Prague, Czech Republic

299 T. Hyanek Department of Intensive Care Medicine, Na Homolce Hospital, 150 30 Prague, Czech Republic G. Bellingan UCL Department of Medicine and NIHR University College London Hospitals, Biomedical Research Centre, UK E-mail address: [email protected] E-mail address: [email protected] Accepted 9 November 2013 ª 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jinf.2013.11.003

Treatment of vertebral osteomyelitis Dear Editor, We congratulate Park et al. on their comprehensive study of hematogenous vertebral osteomyelitis due to methicillinresistant Staphylococcus aureus (MRSA).1 The authors reported persistent bacteremia, longer duration of hospitalization, and a higher relapse rate as compared to vertebral osteomyelitis due to methicillin-susceptible S. aureus (MSSA). Most of their patients (60/62) were treated with vancomycin. They suggested longer courses of treatment and targeting of higher vancomycin trough levels in MRSA vertebral osteomyelitis. Economic considerations and increased rates of renal toxicity observed with higher trough levels of vancomycin make these strategies problematic.2 Similar trends in MRSA vertebral osteomyelitis treated with vancomycin prior to the introduction of alternative agents have been previously noted by us.3 We recently reported a retrospective analysis of vertebral osteomyelitis treated with vancomycin or daptomycin which included a lower relapse rate in those patients treated with prolonged daptomycin.4 The majority of these cases were due to MRSA. We recommend consideration of daptomycin therapy for MRSA vertebral osteomyelitis. While daptomycin is not yet approved for use in treating osteomyelitis, issues related to the use of vancomycin and the possibility of improved clinical outcomes make daptomycin an attractive alternative for use in MRSA vertebral osteomyelitis.

Financial disclosures No funding was received for this work. M.S.G. and K.O.C. have served as speakers for Cubist Pharmaceuticals.

References 1. Park K, Chong YP, Kim S, Lee S, Choi S, Lee MS, et al. Clinical characteristics and therapeutic outcomes of hematogenous vertebral osteomyelitis caused by methicillin-resistant Staphylococcus

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aureus. J Infect 2013;67:556e64. http://dx.doi.org/10.1016/j. inf.2013.07.026. 2. van Hal SJ, Paterson DL, Lodise TP. Systematic review and metaanalysis of vancomycin-induced nephrotoxicity associated with dosing schedules that maintain troughs between 15 and 20 milligrams per liter. Antimicrob Agents Chemother 2013;57:734e44. 3. Gelfand MS, Cleveland KO. Vancomycin therapy and the progression of methicillin-resistant Staphylococcus aureus vertebral osteomyelitis. South Med J 2004;97:854e62. 4. Rangaraj G, Cleveland KO, Gelfand MS. Comparative analysis of daptomycin and vancomycin in the treatment of vertebral osteomyelitis. Inf Dis Clin Pract; 2013; October 25. http://dx.doi.org/10.1097/IPC.0000000000000116 [Epub ahead of print].

Michael S. Gelfand Kerry O. Cleveland Department of Medicine, Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, TN, USA *Corresponding author. 1325 Eastmoreland Avenue, Suite 460, Memphis, TN 38104, USA. Tel.: þ1 901 448 5770; fax: þ1 901 448 5940.

E-mail address: [email protected] E-mail address: [email protected] E-mail address: [email protected] (K.O. Cleveland) Accepted 11 November 2013 ª 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jinf.2013.11.004

71.7% and 19.8% of all 14,077 cases, respectively.2 Consequently, 20 infants (1.8 per 100,000 live births) were diagnosed with CRS during the 12-month period between October 2012 and September 2013 in Japan.2 We conducted retrospective and multicentre study to assess how many pregnant Japanese women were susceptible to rubella during the rubella outbreak that occurred in Japan in 2012e2013 after being approved by the Institutional Review Board of each of the six participating hospitals. Data on the rubella immunity determined by haemagglutination inhibition assay (HI test) were available in 20,363 pregnant women who gave birth during the 5-year period between January 2008 and December 2012 at six hospitals located in Hokkaido, Toyama, Tochigi, Tokyo, and Kanagawa prefectures. The data on population immunity for rubella during the 5-year period from 2008 to 2012 were available from the official website of Japan National Institute of Infectious Diseases (JNIID).3 Women with HI titre

Treatment of vertebral osteomyelitis.

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