Abstract
BackgroundVertebral osteomyelitis is a common manifestation of osteomyelitis in adults and associated with considerable morbidity. Limited data exist regarding hematogenous vertebral osteomyelitis. Our objective was to describe the epidemiology and management of hematogenous vertebral osteomyelitis.MethodsWe performed a 2-year retrospective cohort study of adult patients with hematogenous vertebral osteomyelitis at a tertiary care hospital.ResultsSeventy patients with hematogenous vertebral osteomyelitis were identified. The mean age was 59.7 years (±15.0) and 38 (54%) were male. Common comorbidities included diabetes (43%) and renal insufficiency (24%). Predisposing factors in the 30 days prior to admission included bacteremia (19%), skin/soft tissue infection (17%), and having an indwelling catheter (30%). Back pain was the most common symptom (87%). Seven (10%) patients presented with paraplegia. Among the 46 (66%) patients with a microbiological diagnosis, the most common organisms were methicillin-susceptible S. aureus [15 (33%) cases], and methicillin-resistant S. aureus [10 (22%)]. Among the 44 (63%) patients who had a diagnostic biopsy, open biopsy was more likely to result in pathogen recovery [14 (93%) of 15 with open biopsy vs. 14 (48%) of 29 with needle biopsy; p = 0.003]. Sixteen (23%) patients required surgical intervention for therapeutic purposes during admission.ConclusionsThis is one of the largest series of hematogenous vertebral osteomyelitis. A microbiological diagnosis was made in only approximately two-thirds of cases. S. aureus was the most common causative organism, of which almost half the isolates were methicillin-resistant.
Highlights
Vertebral osteomyelitis is a common manifestation of osteomyelitis in adults and associated with considerable morbidity
We performed a retrospective cohort study of patients with hematogenous vertebral osteomyelitis in an effort to gain a better understanding of the current clinical presentation, management and treatment of this disease entity
Among the patients who had a diagnostic biopsy, open biopsy was more likely to result in pathogen recovery [14 (93%) of 15 open biopsies vs. 14 (48%) of 29 needle biopsies; p = 0.003]
Summary
Vertebral osteomyelitis is a common manifestation of osteomyelitis in adults and associated with considerable morbidity. Our objective was to describe the epidemiology and management of hematogenous vertebral osteomyelitis. Termed spondylodiscitis, is a common manifestation of osteomyelitis in adults [1,2]. It encompasses both infection due to a contiguous source, (i.e. post-surgical and trauma) and hematogenous spread [3]. Despite significant differences in pathogenesis, studies on vertebral osteomyelitis often do not distinguish between the specific infectious etiologies [4]. We performed a retrospective cohort study of patients with hematogenous vertebral osteomyelitis in an effort to gain a better understanding of the current clinical presentation, management and treatment of this disease entity The prevalence of vertebral osteomyelitis appears to be increasing, though this may be due to a variety of factors including better diagnostic techniques, an aging and more immunocompromised population, increasing indwelling device
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