Abstract
Purpose
Vertebral osteomyelitis (VO) is an infection of the vertebral body and the adjacent disc space. The aim of our study was to identify outcome-related co-factors of patients with VO treated in the last decade.
Methods and results
We retrospectively identified 105 patients with VO (mean age 66.1 years) who had been treated at our institution from 2004 to 2011. The median time of hospitalization at our institution was 31.5 days, and 44 patients required intensive medical care. Back pain and fever were documented in 66.7 and 33.3 % of cases, respectively. The radiologic diagnosis of VO was made in 94.8 % of all obtained magnetic resonance imaging scans and in 66.2 % of all computed tomography (CT) scans. Biopsies were taken in 71 patients, and the causative organisms were identified in 56.2 % of patients, with Staphylococcus aureus being the predominant pathogen. Fifty-six patients underwent surgical treatment. During hospitalization, infectious complications were observed in 63 patients (60.0 %). The most common complications were psoas, paravertebral and epidural abscesses. Patients with S. aureus infections had a significantly higher rate of infectious complications than those without (76.5 vs. 40.3 %, respectively), and were more frequently treated in intensive care units (58.8 vs. 34.7 %, respectively). Overall in-hospital mortality rate was 12.4 %. Elevated C-reactive protein levels at admission, advanced age and a Charlson Comorbidity Index of ≥2 were associated with higher mortality.
Conclusions
Magnetic resonance imaging currently is the imaging procedure of choice for the radiologic diagnosis of VO. Mortality is attributable in part to co-morbidities. However, infections with S. aureus are frequent in this patient population and are associated with a higher rate of complications and a trend towards higher mortality.
Similar content being viewed by others
References
Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother. 2010;65[Suppl 3]:iii11–24. doi:10.1093/jac/dkq303.
Grammatico L, Baron S, Rusch E, Lepage B, Surer N, Desenclos JC, et al. Epidemiology of vertebral osteomyelitis (VO) in France: analysis of hospital-discharge data 2002–2003. Epidemiol Infect. 2008;136:653–60. doi:10.1017/S0950268807008850.
Digby JM, Kersley JB. Pyogenic non-tuberculous spinal infection: an analysis of thirty cases. J Bone Joint Surg Br. 1979;61:47–55.
Beronius M, Bergman B, Andersson R. Vertebral osteomyelitis in Goteborg, Sweden: a retrospective study of patients during 1990–1995. Scand J Infect Dis. 2001;33:527–32.
Mylona E, Samarkos M, Kakalou E, Fanourgiakis P, Skoutelis A. Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum. 2009;39:10–7. doi:10.1016/j.semarthrit.2008.03.002.
Lew DP, Waldvogel FA. Osteomyelitis. Lancet. 2004;364:369–79. doi:10.1016/S0140-6736(04)16727-5.
Nolla JM, Ariza J, Gomez-Vaquero C, Fiter J, Bermejo J, Valverde J, et al. Spontaneous pyogenic vertebral osteomyelitis in nondrug users. Semin Arthritis Rheum. 2002;31:271–8.
Zimmerli W. Clinical practice. Vertebral osteomyelitis. N Engl J Med. 2010;362:1022–9. doi:10.1056/NEJMcp0910753.
Patzakis MJ, Rao S, Wilkins J, Moore TM, Harvey PJ. Analysis of 61 cases of vertebral osteomyelitis. Clin Orthop Relat Res. 1991;264:178–83.
McHenry MC, Easley KA, Locker GA. Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis. 2002;34:1342–50. doi:10.1086/340102.
Pigrau C, Almirante B, Flores X, Falco V, Rodriguez D, Gasser I, et al. Spontaneous pyogenic vertebral osteomyelitis and endocarditis: incidence, risk factors, and outcome. Am J Med. 2005;118:1287. doi:10.1016/j.amjmed.2005.02.027.
Carragee EJ. Pyogenic vertebral osteomyelitis. J Bone Joint Surg Am. 1997;79:874–80.
Dufour V, Feydy A, Rillardon L, Redondo A, Le Page L, Bert F, et al. Comparative study of postoperative and spontaneous pyogenic spondylodiscitis. Semin Arthritis Rheum. 2005;34:766–71. doi:10.1016/j.semarthrit.2004.08.004.
Fantoni M, Trecarichi EM, Rossi B, Mazzotta V, Di Giacomo G, Nasto LA, et al. Epidemiological and clinical features of pyogenic spondylodiscitis. Eur Rev Med Pharmacol Sci. 2012;16:2–7.
Pola E, Logroscino CA, Gentiempo M, Colangelo D, Mazzotta V, Di Meco E, et al. Medical and surgical treatment of pyogenic spondylodiscitis. Eur Rev Med Pharmacol Sci. 2012;16:35–49.
Krogsgaard MR, Wagn P, Bengtsson J. Epidemiology of acute vertebral osteomyelitis in Denmark: 137 cases in Denmark 1978–1982, compared to cases reported to the National Patient Register 1991–1993. Acta Orthop Scand. 1998;69:513–7.
Rezai AR, Woo HH, Errico TJ, Cooper PR. Contemporary management of spinal osteomyelitis. Neurosurgery. 1999;44:1018–25 (discussion 25–6).
Furitsch M, Trager K, van der Linden M, Spellerberg B. Group A streptococcal vertebral osteomyelitis presenting with acute quadriplegia. Infection. 2011;39:389–91. doi:10.1007/s15010-011-0113-9.
Weinstein MA, Eismont FJ. Infections of the spine in patients with human immunodeficiency virus. J Bone Joint Surg Am. 2005;87:604–9. doi:10.2106/JBJS.C.01062.
Yuste JR, Alfonso M, Bustos C, Quintana J, Rubio M, Villas C, et al. Iliac bone Candida albicans osteomyelitis in a patient with iliac crest bone autograft: a case report and review of the literature. Infection. 2012;40:445–9. doi:10.1007/s15010-012-0276-z.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.
Jensen AG, Espersen F, Skinhoj P, Frimodt-Moller N. Bacteremic Staphylococcus aureus spondylitis. Arch Intern Med. 1998;158:509–17.
Hadjipavlou AG, Mader JT, Necessary JT, Muffoletto AJ. Hematogenous pyogenic spinal infections and their surgical management. Spine (Phila Pa 1976). 2000;25:1668–79.
Sapico FL, Montgomerie JZ. Pyogenic vertebral osteomyelitis: report of nine cases and review of the literature. Rev Infect Dis. 1979;1:754–76.
Graham SM, Fishlock A, Millner P, Sandoe J. The management of Gram-negative bacterial haematogenous vertebral osteomyelitis: a case series of diagnosis, treatment and therapeutic outcomes. Eur Spine J. 2013;22:1845–53. doi:10.1007/s00586-013-2750-4.
Khan MH, Smith PN, Rao N, Donaldson WF. Serum C-reactive protein levels correlate with clinical response in patients treated with antibiotics for wound infections after spinal surgery. Spine J. 2006;6:311–5. doi:10.1016/j.spinee.2005.07.006.
Modic MT, Feiglin DH, Piraino DW, Boumphrey F, Weinstein MA, Duchesneau PM, et al. Vertebral osteomyelitis: assessment using MR. Radiology. 1985;157:157–66.
Enoch DA, Cargill JS, Laing R, Herbert S, Corrah TW, Brown NM. Value of CT-guided biopsy in the diagnosis of septic discitis. J Clin Pathol. 2008;61:750–3. doi:10.1136/jcp.2007.054296.
Gras G, Buzele R, Parienti JJ, Debiais F, Dinh A, Dupon M, et al. Microbiological diagnosis of vertebral osteomyelitis: relevance of second percutaneous biopsy following initial negative biopsy and limited yield of post-biopsy blood cultures. Eur J Clin Microbiol Infect Dis. 2013;. doi:10.1007/s10096-013-1965-y.
Sapico FL, Montgomerie JZ. Vertebral osteomyelitis. Infect Dis Clin North Am. 1990;4:539–50.
Marschall J, Bhavan KP, Olsen MA, Fraser VJ, Wright NM, Warren DK. The impact of prebiopsy antibiotics on pathogen recovery in hematogenous vertebral osteomyelitis. Clin Infect Dis. 2011;52:867–72. doi:10.1093/cid/cir062.
Park KH, Chong YP, Kim SH, Lee SO, Choi SH, Lee MS, et al. Clinical characteristics and therapeutic outcomes of hematogenous vertebral osteomyelitis caused by methicillin-resistant Staphylococcus aureus. J Infect. 2013;67:556–64. doi:10.1016/j.jinf.2013.07.026.
Bhavan KP, Marschall J, Olsen MA, Fraser VJ, Wright NM, Warren DK. The epidemiology of hematogenous vertebral osteomyelitis: a cohort study in a tertiary care hospital. BMC Infect Dis. 2010;10:158. doi:10.1186/1471-2334-10-158.
Bauman GI, Stifel RE. Osteomyelitis of the spine. Ann Surg. 1923;78:119–21.
Lillie P, Thaker H, Moss P, Baruah J, Cullen L, Taylor D, et al. Healthcare associated discitis in the era of antimicrobial resistance. J Clin Rheumatol. 2008;14:234–7. doi:10.1097/RHU.0b013e318181addd.
Acknowledgments
We would like to thank the Publishing Support from AO Foundation, Davos, Switzerland for the image of Fig. 1, which was adapted with permission.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Loibl, M., Stoyanov, L., Doenitz, C. et al. Outcome-related co-factors in 105 cases of vertebral osteomyelitis in a tertiary care hospital. Infection 42, 503–510 (2014). https://doi.org/10.1007/s15010-013-0582-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s15010-013-0582-0