Clinical Characteristics and Outcomes of Healthcare-Associated Hematogenous Vertebral Osteomyelitis

Abstract

Background The incidence of hematogenous vertebral osteomyelitis (HVO) has increased over recent years, likely due to longer life expectancies, higher prevalence of chronic disease, and more effective diagnostic techniques. Recently, healthcare-associated infections, such as catheter-related and procedure-related bloodstream infections, also increase the risk of HVO. The aim of our study was to evaluate the clinical characteristics and outcomes of healthcare-associated HVO (HCA-HVO).Methods We conducted a retrospective chart review of adult patients with microbiologically diagnosed HVO from five tertiary-care hospitals over 8-year period. HCA-HVO was defined as onset of symptoms after 1 month of hospitalization or within 6 months after hospital discharge, or ambulatory manipulations in the 6 months before the diagnosis [Pigrau et al. Medicine (Baltimore) 2015; 94:e365]. We compared the clinical characteristics and outcomes of HCA-HVO with community-acquired HVO (CA-HVO) cases.ResultsIn total, 358 patients with microbiologically diagnosed HVO were included in final analysis. Of these 358 cases, 256 (63.1%) were CA-HVO and 132 (36.9%) were HCA-HVO according to the predefined criteria. The main causative pathogens identified were methicillin-susceptible Staphylococcus aureus (32%), followed by methicillin-resistant S. aureus (MRSA) (26%), aerobic gram-negative bacteria (24%), and Streptococcus species (11%). Compared with CA-HVO cases, patients with HCA-HVO had more neoplasm (13.6% vs. 5.8%, P = 0.01) and end-stage renal disease (8.3% vs. 2.2%, P = 0.007). MRSA was more frequent pathogens in HCA-HVO cases than in CA-HVO (37.1% vs. 17.7%, P = 0.01). Patients with HCA-HVO were more likely to be have the higher rates of persistent bacteremia for ≥7 days (24.2% vs. 15.5%, P = 0.04), 1-year mortality (18.2% vs. 11.5%, P = 0.08) and 1-year relapse (12.1% vs. 6.2%, P = 0.051).Conclusion In this study, more than one-third of HVO is health care associated. Patients with HCA-HVO were more likely to have underlying illness, and their causative pathogens were more frequently MRSA. Outcomes of HCA-HVO were poorer, which require prevention measures and early diagnosis.Disclosures All authors: No reported disclosures.