Comparison of pyogenic postoperative and native vertebral osteomyelitis

Kim, Uh Jin; Bae, Jae‐Young; Kim, Seong Eun; Kim, Chung Jong; Kang, Suna; Jang, Hee Chang; Jung, Sook In; Song, Kyoung Ho; Kim, Eu Suk; Kim, Hong Bin; Park, Wan Beom; Kim, Nam Joong; Park, Kyung Hwa

doi:10.1016/j.spinee.2018.11.012

Cited by 31 publications

(38 citation statements)

References 32 publications

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“…In a retrospective series of 345 cases of proven pyogenic VO, of which 74% were bacteraemic, median CRP was 13.1 mg/dL (IQR 5.5-22.0) and ESR 77mm/hour (IQR 55-100) [25]. In another retrospective series of 440 native pyogenic VO not associated with surgery, of which 78% was bacteraemic, mean ESR was 68±31mm/hour and CRP was 13.5±9.5mg/dL [26].Similarly a study of 42 surgically treated pyogenic VO with bacteraemia in 31%, the mean ESR was 42mm/hour (range, 3-140) and CRP was 14mg/L (range, 1-29) on admission [27]. CRP can be elevated too; in a retrospective study of 40 patients with VO with 43% bacteraemia, the mean ESR was 79±27mm/hour and CRP 165±79mg/L on admission [28].…”

Section: D Role Of Erythrocyte Sedimentation Rate (Esr) and C-reactimentioning

confidence: 98%

Hot topics on vertebral osteomyelitis from the International Society of Antimicrobial Chemotherapy

Saeed

Esposito

Ascione³

et al. 2019

International Journal of Antimicrobial Agents

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Vertebral osteomyelitis (VO), also known as spondylodiscitis, describes infections of the vertebrae and intervertebral discs. Discitis describes infection limited to the intervertebral discs; in clinical practice both discitis and VO can be regarded as different stages of a single entity. VO can be caused by bacteria, fungi and parasites The incidence of VO is increasing globally representing 3-5% of all osteomyelitis with an estimated incidence ranging from 4 to 24 per million per year. Increasing incidence has been attributed to a combination of improved diagnostics, increased healthcare associated infections, haemodialysis, indwelling catheters, intravenous drug use, spinal instrumentation, immunocompromised hosts and an ageing population [1]. If left untreated, VO can lead to irreversible spinal cord injury, deformity, neurologic deficits, septicaemia, and mortality (mortality rates ranges 4%-29%). VO is typically treated with antibiotics, but up to 40% to 50% of VO patients may eventually require surgical intervention [1-3] Despite advances in diagnostic modalities, medical and surgical care, there are still many controversial areas with regards to both diagnostic and therapeutic strategies in VO. In this review a number of 'hot topics' on VO were selected and reviewed by members of the Skin, Soft Tissue and Bone Infections Working Group of the International Society of Antimicrobial Chemotherapy (ISAC). This group includes international scientists, microbiology and infectious diseases clinicians and academics, whose aim is to advance the education and the science of infection management. This paper is an in-depth review of the current literature, providing a summary of the various aspects of VO and expert opinions and insights from the authors' own experience, highlighting areas for future study and research.

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Section: D Role Of Erythrocyte Sedimentation Rate (Esr) and C-reactimentioning

confidence: 98%

Hot topics on vertebral osteomyelitis from the International Society of Antimicrobial Chemotherapy

Saeed

Esposito

Ascione³

et al. 2019

International Journal of Antimicrobial Agents

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“…The success of PVO treatment is regularly evaluated in studies in terms of relapse rate after completed antibiotic treatment (Chang et al, 2018;Lee et al, 2019;Park et al, 2016). However, evaluation of treatment response, during the course of treatment, is less frequently addressed (Kim et al, 2014;Kim et al, 2019b;Patel et al, 2014). Our hypothesis was that a substantial proportion of PVO patients respond inadequately to the initial treatment strategy following diagnosis of PVO.…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics of pyogenic vertebral osteomyelitis, and factors associated with inadequate treatment response

Crone

Tetens

Andersen

et al. 2021

International Journal of Infectious Diseases

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Pyogenic vertebral osteomyelitis (PVO) is associated with a high burden of disease. Our study aimed to describe characteristics at presentation of PVO, the risk of inadequate treatment response (ITR), relapse, and death, and to determine risk factors for ITR. Methods: Patients with an ICD-10 discharge code for PVO and admission to a major Danish university hospital between November 2016 and April 2019 were included. ITR was defined as clinical, microbiological, and/or radiological progression during treatment. Data were collected through review of medical records, and logistic regression was used to determine adjusted odds ratios (aOR). Results: Of 106 patients included, 87% presented with pain in the spine, 97% elevated CRP, 14% severe sepsis, and 13% with a history of previous spinal surgery. 39% were infected with Staphylococcus aureus and 9% with Escherichia coli. 31% responded inadequately to treatment, and risk factors for ITR were previous spinal surgery (aOR 19.29; 95% confidence interval (CI) 2.20-169.08), severe sepsis (aOR 4.59; 95% CI 1.28-15.41), and infection with Escherichia coli (aOR 8.10; 95% CI 1. 71-38.45). 13% experienced relapse within the first 2 years, while the 1-year crude mortality was 12%. Conclusion: Staphylococcus aureus is still the main pathogen in PVO patients, and the risks of relapse and mortality remain high. Factors found to be associated with ITR were previous spinal surgery, severe sepsis, and infection with Escherichia coli.

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“…Although small, the study cohort was of similar composition to other reports on pyogenic spinal column infection. We found a male predominance and a mean age of 63.3 years-Kim et al 30 reported on a cohort of 441 patients with native vertebral osteomyelitis-63% were male and the mean age was 64 years. In a systematic review of 50 studies assessing treatment of spondylodiscitis, Taylor et al 31 reported a male majority (60%) and a mean age of 58.3 years.…”

Section: Discussionmentioning

confidence: 47%

Radiographic Features Associated With Increased Surgical Invasiveness in Pyogenic Vertebral Column Osteomyelitis

Purea

Vettivel

Hunt

et al. 2020

Global Spine Journal

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Study Design: Single center retrospective cohort study. Objectives: Assess the association between well-known radiographic features for spinal instability from the Spinal Instability in Neoplasia Score (SINS) and surgical invasiveness in treating vertebral column osteomyelitis (VCO). This will potentially help surgeons in surgical planning and aid in developing a pathology specific score. Methods: Patients with VCO were identified from hospital coding. On preoperative computed tomography radiographic features, including spinal alignment, vertebral body collapse, location, type of bone lesion, and posterolateral involvement were assessed and scored 0 (stable) to 15 (highly unstable). Surgical invasiveness was graded as 0 = no surgery, 1 = decompression alone, 2 = shortening or posterior stabilization, or 3 = anterior column reconstruction. Results: A total of 41 patients were included. The mean age of the cohort was 63.3 years (SD 12.0) with male comprising 78%. The mean total radiographic score for the nonsurgical group was 6.39 (3.14) and for the surgical group 10.38 (3.06), P < .001. Spinal alignment, vertebral body collapse, type of bone lesion, and posterolateral involvement correlated with surgical invasiveness (all Ps < .05). Subgroup comparison following analysis of variance showed that only spinal alignment was significantly different between groups 2 and 3. Conclusions: Our findings show correlation of the radiographic components of the SINS with surgical invasiveness in management of pyogenic VCO—these findings should aid development of an “instability score” in pyogenic VCO. While most radiographic features assessed correlated with surgical invasiveness spinal alignment appears to be the key feature in determining the need for more invasive surgery.

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Comparison of pyogenic postoperative and native vertebral osteomyelitis

Cited by 31 publications

References 32 publications

Hot topics on vertebral osteomyelitis from the International Society of Antimicrobial Chemotherapy

Hot topics on vertebral osteomyelitis from the International Society of Antimicrobial Chemotherapy

Clinical characteristics of pyogenic vertebral osteomyelitis, and factors associated with inadequate treatment response

Radiographic Features Associated With Increased Surgical Invasiveness in Pyogenic Vertebral Column Osteomyelitis

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