Abstract
The causative organism of vertebral osteomyelitis (VO) was almost exclusively Staphylococcus aureus. The purpose of this study was to delineate the differences in clinical features and outcomes between patients with methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) VO. This study retrospectively reviewed 85 consecutive patients with VO treated between 2005 and 2011. Surgical site infections were excluded. Diagnosis was made by cultures of either blood or biopsied samples. We identified 16 cases of MRSA VO and 14 cases of MSSA VO. The average follow-up period was 18.5 months. Clinical features and outcomes were analyzed. Males were more likely to have MRSA VO than MSSA VO (87.5% vs. 35.7%). In regards to the number of co-morbidities, patients with MRSA VO had significantly more co-mobidities than patients with MSSA VO. Additionally, the rate of patients who underwent surgical procedure (excluding spinal surgeries in the affected region) within 3 months were significantly higher in the MRSA VO group than the MSSA VO group (56.3% vs. 14.3%). White blood cell counts and C-reactive protein levels in patients with both strains significantly improved 4 weeks after the initial treatment compared with the pretreatment values. The recurrence rate within 6 months tended to be higher for MRSA VO (37.5% vs. 7.1%), but no significant difference in mortality was observed between the two VO types. In conclusion, male sex, multiple co-morbidities and previous non-spine surgery were significant risk factors for VO due to MRSA as compared to MSSA. The recurrence rate within 6 months tended to be higher for MRSA VO. Patients with MRSA VO should be monitored carefully for recurrence by sequential clinical, radiographic, and laboratory examinations during the treatment course.
Highlights
The number of patients with pyogenic vertebral osteomyelitis (VO) has increased steadily in recent years (Zimmerli 2010; Mylona et al 2009; Cebrián Parra et al 2012)
The recurrence rate within 6 months tended to be higher in the methicillin-resistant Staphylococcus aureus (MRSA) VO group (37.5% vs. 7.1%, P = 0.086), whereas no significant difference in mortality was observed between the groups (12.5% vs. 21.4%, P = 0.642)
The present study showed the preceding surgical procedure was a factor associated with occurrence of MRSA VO
Summary
The number of patients with pyogenic vertebral osteomyelitis (VO) has increased steadily in recent years (Zimmerli 2010; Mylona et al 2009; Cebrián Parra et al 2012). Previous studies have demonstrated a significant increase in mortality among patients who had MRSA bacteremia compared with mortality among patients who had MSSA bacteremia (Cosgrove et al 2003; Shurland et al 2007). In regards to other infectious diseases (meningitis (Chang et al 2001), endocarditis (Yoon et al 2005), arthritis (Al-Nammari et al 2007a), liver abscess (Ferreira et al 2011), and spinal epidural abscess (Huang et al 2012)), there have been recent studies comparing the clinical characteristics of infection caused by MSSA and MRSA strains
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