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Pyogenic vertebral osteomyelitis: identification of microorganism and laboratory markers used to predict clinical outcome

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Abstract

The aim of this study is to determine the predictive values of laboratory indicators of pyogenic vertebral osteomyelitis (PVO) and a potential cure if the microorganism cannot be identified. Forty-five consecutive patients with PVO were enrolled. Antibiotic therapy with or without surgery was performed according to microorganism. In the negative-culture (NC) group, cefazolin was administered in cases of hematogenous PVO, and vancomycin was administered in cases of postoperative or procedure-related PVO. The clinical, laboratory, and radiological findings were followed up with regard to an appropriate response to antimicrobial therapy. Nine patients were treated with antibiotics alone. We were able to identify the microorganism in 34 cases (75.6%). Ten cases in NC group were cured without recurrence, but one was not. Identification of the microorganisms did not have any significant influence on the treatment outcome, duration of antibiotic administration or normalization of laboratory profiles. For erythrocyte sedimentation rate (ESR) values over 55 mm/h and C-reactive protein (CRP) values of 2.75 mg/dL at fourth week after antibiotic administration by means of ROC curve analysis, we expect significantly high rates of treatment failure by Pearson χ2 test (χ2 = 4.344, Odds ratio = 5.15, p = 0.037, 95% CI 1.004–26.597). Even in patients with negative culture findings, it is expected that a good outcome will be achieved by the administration of cefazolin or vancomycin for about 6 weeks. It is concluded that antibiotics selected according to the etiological setting can be initiated without the need to start empirical antibiotics. In every instance at fourth week after the initiation of antibiotic therapy, the values of CRP and ESR can provide meaningful information regarding whether clinicians need to reevaluate the effectiveness of antibiotics by performing follow-up imaging studies and monitoring the patient’s clinical manifestations.

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References

  1. Hadjipavlou AG, Mader JT, Necessary JT, Muffoletto AJ (2000) Hematogenous pyogenic spinal infections and their surgical management. Spine 25:1668–1679

    Article  CAS  PubMed  Google Scholar 

  2. Mann S, Schutze M, Sola S, Piek J (2004) Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients. Neurosurg Focus 17:E3. doi:170603[pii]

    Article  PubMed  Google Scholar 

  3. Osenbach RK, Zeidman SM (1999) Infections in neurological surgery: diagnosis & management. Lippincott-Raven, Philadelphia

    Google Scholar 

  4. Belzunegui J, Intxausti JJ, De Dios JR, Del Val N, Rodriguez Valverde V, Gonzalez C, Queiro R, Figueroa M (2000) Haematogenous vertebral osteomyelitis in the elderly. Clin Rheumatol 19:344–347

    Article  CAS  PubMed  Google Scholar 

  5. Gasbarrini AL, Bertoldi E, Mazzetti M, Fini L, Terzi S, Gonella F, Mirabile L, Barbanti Brodano G, Furno A, Gasbarrini A, Boriani S (2005) Clinical features, diagnostic and therapeutic approaches to haematogenous vertebral osteomyelitis. Eur Rev Med Pharmacol Sci 9:53–66

    CAS  PubMed  Google Scholar 

  6. Bhagat S, Mathieson C, Jandhyala R, Johnston R (2007) Spondylodiscitis (disc space infection) associated with negative microbiological tests: comparison of outcome of suspected disc space infections to documented non-tuberculous pyogenic discitis. Br J Neurosurg 21:473–477. doi:10.1080/02688690701546155 781030226[pii]

    Article  CAS  PubMed  Google Scholar 

  7. Bontoux D, Codello L, Debiais F, Lambert de Cursay G, Azais I, Alcalay M (1992) Infectious spondylodiscitis. Analysis of a series of 105 cases. Rev Rhum Mal Osteoartic 59:401–407

    CAS  PubMed  Google Scholar 

  8. Carragee EJ (1997) Pyogenic vertebral osteomyelitis. J Bone Joint Surg Am 79:874–880

    Article  CAS  PubMed  Google Scholar 

  9. Chelsom J, Solberg CO (1998) Vertebral osteomyelitis at a Norwegian university hospital 1987–97: clinical features, laboratory findings and outcome. Scand J Infect Dis 30:147–151

    Article  CAS  PubMed  Google Scholar 

  10. Mylona E, Samarkos M, Kakalou E, Fanourgiakis P, Skoutelis A (2008) Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum. doi:S0049-0172(08)00070-X [pii] 10.1016/j.semarthrit.2008.03.002

  11. Roblot F, Besnier JM, Juhel L, Vidal C, Ragot S, Bastides F, Le Moal G, Godet C, Mulleman D, Azais I, Becq-Giraudon B, Choutet P (2007) Optimal duration of antibiotic therapy in vertebral osteomyelitis. Semin Arthritis Rheum 36:269–277. doi:10.1016/j.semarthrit.2006.09.004 S0049-0172(06)00140-5[pii]

    Article  CAS  PubMed  Google Scholar 

  12. Acosta FL Jr, Chin CT, Quinones-Hinojosa A, Ames CP, Weinstein PR, Chou D (2004) Diagnosis and management of adult pyogenic osteomyelitis of the cervical spine. Neurosurg Focus 17:E2. doi:170602[pii]

    Article  PubMed  Google Scholar 

  13. Hopkinson N, Stevenson J, Benjamin S (2001) A case ascertainment study of septic discitis: clinical, microbiological and radiological features. QJM 94:465–470

    Article  CAS  PubMed  Google Scholar 

  14. Lam KS, Webb JK (2004) Discitis. Hosp Med 65:280–286

    PubMed  Google Scholar 

  15. An HS (1998) Principles and techniques of spine surgery. Williams & Wilkins, Baltimore

    Google Scholar 

  16. Colmenero JD, Jimenez-Mejias ME, Sanchez-Lora FJ, Reguera JM, Palomino-Nicas J, Martos F, Garcia de las Heras J, Pachon J (1997) Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases. Ann Rheum Dis 56:709–715

    Article  CAS  PubMed  Google Scholar 

  17. Jensen AG, Espersen F, Skinhoj P, Frimodt-Moller N (1998) Bacteremic Staphylococcus aureus spondylitis. Arch Intern Med 158:509–517

    Article  CAS  PubMed  Google Scholar 

  18. Kowalski TJ, Berbari EF, Huddleston PM, Steckelberg JM, Osmon DR (2006) Do follow-up imaging examinations provide useful prognostic information in patients with spine infection? Clin Infect Dis 43:172–179. doi:10.1086/505118 CID38937[pii]

    Article  PubMed  Google Scholar 

  19. Legrand E, Flipo RM, Guggenbuhl P, Masson C, Maillefert JF, Soubrier M, Noel E, Saraux A, Di Fazano CS, Sibilia J, Goupille P, Chevalie X, Cantagrel A, Conrozier T, Ravaud P, Liote F (2001) Management of nontuberculous infectious discitis. Treatments used in 110 patients admitted to 12 teaching hospitals in France. Joint Bone Spine 68:504–509

    Article  CAS  PubMed  Google Scholar 

  20. Nolla JM, Ariza J, Gomez-Vaquero C, Fiter J, Bermejo J, Valverde J, Escofet DR, Gudiol F (2002) Spontaenous pyogenic vertebral osteomyelitis in nondrug users. Semin Arthritis Rheum 31:271–278. doi:S0049017202404416[pii]

    Article  PubMed  Google Scholar 

  21. Sapico FL, Montgomerie JZ (1990) Vertebral osteomyelitis. Infect Dis Clin North Am 4:539–550

    CAS  PubMed  Google Scholar 

  22. McHenry MC, Easley KA, Locker GA (2002) Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis 34:1342–1350. doi:10.1086/340102 CID011182[pii]

    Article  PubMed  Google Scholar 

  23. Osenbach RK, Hitchon PW, Menezes AH (1990) Diagnosis and management of pyogenic vertebral osteomyelitis in adults. Surg Neurol 33:266–275. doi:0090-3019(90)90047-S[pii]

    Article  CAS  PubMed  Google Scholar 

  24. Emery SE, Chan DP, Woodward HR (1989) Treatment of hematogenous pyogenic vertebral osteomyelitis with anterior debridement and primary bone grafting. Spine 14:284–291

    CAS  PubMed  Google Scholar 

  25. Schimmer RC, Jeanneret C, Nunley PD, Jeanneret B (2002) Osteomyelitis of the cervical spine: a potentially dramatic disease. J Spinal Disord Tech 15:110–117

    PubMed  Google Scholar 

  26. Borowski AM, Crow WN, Hadjipavlou AG, Chaljub G, Mader J, Cesani F, vanSonnenberg E (1998) Interventional radiology case conference: the University of Texas Medical Branch. Percutaneous management of pyogenic spondylodiskitis. AJR Am J Roentgenol 170:1587–1592

    CAS  PubMed  Google Scholar 

  27. Collert S (1977) Osteomylelitis of the spine. Acta Orthop Scand 48:283–290

    Article  CAS  PubMed  Google Scholar 

  28. Rath SA, Neff U, Schneider O, Richter HP (1996) Neurosurgical management of thoracic and lumbar vertebral osteomyelitis and discitis in adults: a review of 43 consecutive surgically treated patients. Neurosurgery 38:926–933

    Article  CAS  PubMed  Google Scholar 

  29. Cottle L, Riordan T (2008) Infectious spondylodiscitis. J Infect 56:401–412. doi:10.1016/j.jinf.2008.02.005 S0163-4453(08)00085-6[pii]

    Article  PubMed  Google Scholar 

  30. Grados F, Lescure FX, Senneville E, Flipo RM, Schmit JL, Fardellone P (2007) Suggestions for managing pyogenic (non-tuberculous) discitis in adults. Joint Bone Spine 74:133–139. doi:10.1016/j.jbspin.2006.11.002 S1297-319X(07)00006-1[pii]

    Article  PubMed  Google Scholar 

  31. Sapico FL, Montgomerie JZ (1979) Pyogenic vertebral osteomyelitis: report of nine cases and review of the literature. Rev Infect Dis 1:754–776

    CAS  PubMed  Google Scholar 

  32. Khan IA, Vaccaro AR, Zlotolow DA (1999) Management of vertebral diskitis and osteomyelitis. Orthopedics 22:758–765

    CAS  PubMed  Google Scholar 

  33. Tali ET (2004) Spinal infections. Eur J Radiol 50:120–133. doi:10.1016/j.ejrad.2003.10.022 S0720048X03003097[pii]

    Article  PubMed  Google Scholar 

  34. Fraser RD, Osti OL, Vernon-Roberts B (1989) Iatrogenic discitis: the role of intravenous antibiotics in prevention and treatment. An experimental study. Spine 14:1025–1032

    Article  CAS  PubMed  Google Scholar 

  35. Winn HR, Youmans JR (2004) Youmans neurological surgery. Saunders, Philadelphia

    Google Scholar 

  36. Zarrouk V, Feydy A, Salles F, Dufour V, Guigui P, Redondo A, Fantin B (2007) Imaging does not predict the clinical outcome of bacterial vertebral osteomyelitis. Rheumatology (Oxford) 46:292–295. doi:10.1093/rheumatology/kel228 kel228[pii]

    Article  CAS  Google Scholar 

  37. An HS, Seldomridge JA (2006) Spinal infections: diagnostic tests and imaging studies. Clin Orthop Relat Res 444:27–33. doi:10.1097/01.blo.0000203452.36522.9700003086-200603000-00006[pii]

    Article  PubMed  Google Scholar 

  38. Lee DG, Park KB, Kang DH, Hwang SH, Jung JM, Han JW (2007) A clinical analysis of surgical treatment for spontaneous spinal infection. J Korean Neurosurg S 42:317–325

    Article  Google Scholar 

  39. Bengzon J, Grubb A, Bune A, Hellstrom K, Lindstrom V, Brandt L (2003) C-reactive protein levels following standard neurosurgical procedures. Acta Neurochir (Wien) 145:667–670. doi:10.1007/s00701-003-0083-5 (discussion 670–671)

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea

    Sang Hoon Yoon, Sang Ki Chung, Ki-Jeong Kim, Hyun-Jib Kim & Yong Jun Jin

  2. Division of Infectious Diseases, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea

    Hong Bin Kim

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  1. Sang Hoon Yoon
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Correspondence to Sang Ki Chung.

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Yoon, S.H., Chung, S.K., Kim, KJ. et al. Pyogenic vertebral osteomyelitis: identification of microorganism and laboratory markers used to predict clinical outcome. Eur Spine J 19, 575–582 (2010). https://doi.org/10.1007/s00586-009-1216-1

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  • DOI: https://doi.org/10.1007/s00586-009-1216-1

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