High mortality from pyogenic vertebral osteomyelitis: a retrospective cohort study.

Abstract

Retrospective cohort study. In this pilot study, we aimed to assess the incidence, diagnostic strategies, treatment regimens, and outcomes of pyogenic vertebral osteomyelitis (PVO), in a non-urban, Northern European population during 1 year. Region Zealand, Denmark. All patients admitted to a hospital in Region Zealand during 2013 and subsequently discharged with a diagnosis of PVO or discitis were eligible for screening. Discharge diagnosis codes were obtained from a central register and patients were identified with unique identification numbers from the Danish Civil Registration System. Forty-one consecutive patients were included. Patients presented with back pain (78%), fever (76%), elevated C-reactive protein levels (95%), and bacteremia (76%). Nine patients (22%) were treated empirically, as no bacterial etiology was isolated from blood culture or biopsy. The median duration of antibiotic treatment was 92 days, and we report an in-hospital mortality of 15%. This study supports previous findings of increasing incidence of PVO. In addition, we found a high rate of bacteremia and a high mortality in this single year cohort. Treatment regimens were heterogeneous and prolonged, due to delayed diagnosis and various or unknown microbial etiology. The study suggests that back pain, fever, and increased C-reactive protein levels are frequent in patients with PVO, and efforts should be made on securing early diagnosis and microbial etiology. Further studies of predictors of different clinical outcomes are warranted. Treatment of culture-negative cases and clinical value of bone biopsies are of special interest.