Haematogenous Vertebral Osteomyelitis in the Elderly

Abstract

The aim of our study was to analyse the characteristics of haematogenous vertebral osteomyelitis (HVO) in the elderly. A retrospective comparative analysis of the medical records of 72 patients (38 younger than 63 years, group 1, and 34 aged 63 years and over, group 2) with haematogenous vertebral osteomyelitis of confirmed aetiology was carried out. Intravenous drug addiction and infection with the human immunodeficiency virus were seen in 4/38 (10%) and 5/38 (13%) patients from group 1 and 0/34 patients (0%) from group 2 (P = 0.05 and 0.035, respectively). Seven of 34 elderly (20%) and 0/38 (0%) young individuals had recently had surgery (P = 0.0036). Escherichia coli was isolated in 7/34 elderly (20%) and 0/38 (0%) young patients (P = 0.0036). The remaining studied data did not reach statistical significance. Recent surgery is a risk factor for developing HVO in the elderly, the urinary tract being the source of the pathogen in a large number of elderly patients with spinal infection.

Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation

“…The onset of the symptom is often insidious and could easily be underestimated (or ignored) by both patients and doctors. Patients could present a great diversity of pathologic features, clinical manifestations, and various complications [7,26,46]. The most common symptom is axial pain; it may be insidious in onset during the early stages of infection but typically worsen at the advanced stage.…”

“…It has been extensively reported that the most common causative pathogen is Staphylococcus aureus (S. aureus), followed in frequency by Streptococcus species, Escherichia coli, Staphylococcus epidermis, Aeruginosus Bacillus and Pseudomonas [7,8,17,19,31,35,36,47,52,56,64,71]. A large scale study singled out S. aureus as the most common infective agent with a frequency as high as 48% (123/255).…”

“…This incidence is increasing, which may be attributable to various factors such as the aging of the society, the abuse of intravenous drugs, the widespread use of immunosuppression therapy for organ implant recipient and the progress in diagnostic methods with higher specificity [7]. These diseases often affect the ''at-risk'' populations, namely the elderly and the immunocomprimised.…”

“…Most frequently involved is the lumbar region, followed by the thoracic, and then the cervical spine, but the sacrum is seldom affected. Predilection for male population has also been well documented [7,8,17,31,35,36,46,47,52,56]. Spinal infections are often preceded by infections elsewhere in the body; and predisposing conditions include a genitourinary infection, urinary tract intervention, intravenous drug abuse, AIDS, immunosuppression, indwelling vascular catheter, diabetes mellitus and cancer [7,21,71].…”

Hämatogene Spondylitis

“…Spondylodiszitis weiterhin eine Herausforderung dar. Ihre Inzidenz beträgt etwa 2,2:100.000, wobei in den letzten Jahren eine Zunahme zu verzeichnen war, welche auf die zunehmend ältere Bevölkerung mit der daraus resultierenden Multimorbidität sowie auf verbesserte diagnostische Möglichkeiten mit einer höheren Spezifität zurückgeführt werden kann [1]. Am häufigsten betroffen ist die lumbale Wirbelsäule [7].…”