Abstract
BackgroundThe incidence of pyogenic vertebral osteomyelitis (PVO) has increased over the past two decades. One possible cause of this increase is the aging of the population, which results in more comorbidities in high income countries.ObjectiveTo better characterize the clinical presentation and outcome of PVO in the elderly.DesignWe conducted a post-hoc analysis of a previously published trial that studied treatment duration in PVO and compared the presentation and outcomes according to age.ParticipantsOur analysis included 351 patients among whom 85 (24%) were 75-years-old or more.ResultsThere were no significant differences in the socio-demographics of the patients. Neoplasia and chronic inflammatory diseases were more common in the older group: 34% vs. 19% (p = 0.021) and 9% versus 1% (p = 0.004), respectively. There were no significant differences in clinical and radiological presentations between the groups in terms of back pain (337/351, 97%), fever (182/351, 52%), PVO localization, neurological signs and epidural abscess. Associated infective endocarditis (IE) was more frequent in the older group (37% vs. 14%, p<0.001). Streptococci were more frequently involved in infections of older patients (29% vs. 14%, p = 0.003) in contrast to Staphylococcus aureus (31% vs. 45%, p = 0.03). Older patients displayed higher mortality rates at 1 year (21% vs. 3%, p<0.001) and more adverse events related to cardiorespiratory failure (10.6% vs. 3.8%, p = 0.025), but had similar quality of life among the survivors.ConclusionDuring PVO, the clinical and radiological findings are similar in older patients. Global mortality rates are higher in older patients compared to younger patients, which could be explained by the increased frequency of neoplasia at diagnosis and higher prevalence of associated IE in the elderly.
Highlights
Pyogenic vertebral osteomyelitis (PVO) is a rare condition with an estimated annual incidence in France of 2.4/100 000 inhabitants
During pyogenic vertebral osteomyelitis (PVO), the clinical and radiological findings are similar in older patients
Global mortality rates are higher in older patients compared to younger patients, which could be explained by the increased frequency of neoplasia at diagnosis and higher prevalence of associated infective endocarditis (IE) in the elderly
Summary
Pyogenic vertebral osteomyelitis (PVO) is a rare condition with an estimated annual incidence in France of 2.4/100 000 inhabitants. In patients aged 70 years or more, the incidence reached 6.5/100 000 inhabitants in 2002–2003 [1]. A recent Spanish study that analyzed the trends in bone and joint infections reported an increasing incidence of PVO in older patients Back pain has been reported in 86% of PVO cases [3], but such a complaint is common and is made by up to 40% of females between 60 and 69 years of age [4]. The impact of age on the outcomes of PVO has differed across many studies. The incidence of pyogenic vertebral osteomyelitis (PVO) has increased over the past two decades. One possible cause of this increase is the aging of the population, which results in more comorbidities in high income countries
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