Vertebral Osteomyelitis In Adults Research Articles

Diagnostic efficacy and clinical impact of image-guided core needle biopsy of suspected vertebral osteomyelitis

ObjectivesThe diagnostic yield and clinical impact of image-guided core needle biopsy (ICNB) of suspected vertebral osteomyelitis in adults is heterogenous in published studies owing to small sample sizes, indicating the need for large cohort studies. MethodsA retrospective analysis of ICNBs was performed from 2010 to 2021 for patients with imaging findings consistent with vertebral osteomyelitis. For each biopsy, a series of factors were analyzed, as well as if histopathology was diagnostic of osteomyelitis and if microbiological cultures were positive. In addition, it was recorded in what way biopsy influenced clinical management regarding antimicrobial treatment. A multivariate statistical analysis was performed to evaluate the factors associated with yield. ResultsA total of 570 biopsies performed on 527 patients were included. A histopathologic diagnosis of osteomyelitis was made in 68.4% (359 of 525) of biopsies, and microbiological cultures were positive in 29.6% (169 of 570). Elevated erythrocyte sedimentation rate was positively associated with a histopathologic diagnosis of osteomyelitis (odds ratio [OR] =1.96, P = 0.007) and positive cultures from bone cores (OR = 1.02, P ≤0.001) and aspirate (OR = 1.02, P ≤0.001). Increased total core length was positively associated with a histopathologic diagnosis of osteomyelitis (OR = 1.81, P = 0.013) and positive cultures from bone cores (OR = 1.65, P = 0.049). Clinical management was affected by ICNB in 37.5% (214 of 570) of cases. ConclusionsIn this large cohort, ICNB yielded approximately 30% positive cultures and changed clinical management in over one-third of the patients.

Management of vertebral osteomyelitis in adults.

Vertebral osteomyelitis is a condition that predominantly affects older men with chronic comorbidities, such as diabetes, renal and hepatic failure, or immunosuppression. Symptoms develop insidiously and a high index of suspicion is required to diagnose the condition; this is achieved through serological testing and imaging. The mainstay of treatment is long-term antibiotic therapy, lasting a minimum of 6 weeks; however, surgical debridement with stabilisation is required when conservative treatment is proving ineffective and infection progresses. It is critically important that sufficient treatment is provided for those experiencing vertebral osteomyelitis, as not doing so could lead to severe neurological compromise and death.

Antibiotic Treatment of Vertebral Osteomyelitis caused by Methicillin-Susceptible Staphylococcus aureus: A Focus on the Use of Oral β-lactams.

BackgroundVertebral osteomyelitis (VO) is a rare but serious condition, and a potentially significant cause of morbidity. Methicillin-susceptible Staphylococcus aureus (MSSA) is the most common microorganism in native VO. Long-term administration of parenteral and oral antibiotics with good bioavailability and bone penetration is required for therapy. Use of oral β-lactams against staphylococcal bone and joint infections in adults is not generally recommended, but some experts recommend oral switching with β-lactams. This study aimed to describe the current status of antibiotic therapy and treatment outcomes of oral switching with β-lactams in patients with MSSA VO, and to assess risk factors for treatment failure.Materials and MethodsThis retrospective study included adult patients with MSSA VO treated at nine university hospitals in Korea between 2005 and 2014. Treatment failure was defined as infection-related death, microbiological relapse, neurologic deficits, or unplanned surgical procedures. Clinical characteristics and antibiotic therapy in the treatment success and treatment failure groups were compared. Risk factors for treatment failure were identified using the Cox proportional hazards model.ResultsA total of 100 patients with MSSA VO were included. All patients were treated, initially or during antibiotic therapy, with one or more parenteral antibiotics. Sixty-nine patients received one or more oral antibiotics. Antibiotic regimens were diverse and durations of parenteral and oral therapy differed, depending on the patient and the hospital. Forty-two patients were treated with parenteral and/or oral β-lactams for a total duration of more than 2 weeks. Compared with patients receiving parenteral β-lactams only, no significant difference in success rates was observed in patients who received oral β-lactams for a relatively long period. Sixteen patients had treatment failure. Old age (adjusted hazard ratio [HR] 5.600, 95% confidence interval [CI] 1.402 – 22.372, P = 0.015) and failure to improve C-reactive protein levels at follow-up (adjusted HR 3.388, 95% CI 1.168 – 9.829, P = 0.025) were independent risk factors for treatment failure.ConclusionIn the study hospitals, diverse combinations of antibiotics and differing durations of parenteral and oral therapy were used. Based on the findings of this study, we think that switching to oral β-lactams may be safe in certain adult patients with MSSA VO. Since limited data are available on the efficacy of oral antibiotics for treatment of staphylococcal VO in adults, further evaluation of the role of oral switch therapy with β-lactams is needed.

Executive Summary: 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults.

These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neurosurgeons, radiologists, and other healthcare professionals who care for patients with native vertebral osteomyelitis (NVO). They include evidence and opinion-based recommendations for the diagnosis and management of patients with NVO treated with antimicrobial therapy, with or without surgical intervention.

THE CLASSIC: Pyogenic Vertebral Osteomyelitis

THE CLASSIC: Pyogenic Vertebral Osteomyelitis

Vertebral osteomyelitis: a complication of urological surgery.

Abstract Three patients who developed vertebral osteomyelitis following genito-urinary surgery are presented. In each patient a persistent urinary tract infection was noted. Some months after operation these patients developed severe back pain, hut the correct diagnosis WIS not made initially because spinal X-rays were at first normal. In I patienr an abnormal gamma bone scan was thought, mistakenly, to be diagnostic of metastatic bone disease and it was only when the pain increased after radiotherapy that a diagnosis of. spinal osteomyelitis was considered. The incidence of vertebral osteomyelitis in adults uppears to be increasing, and in order to make the correct diagnosis a high index of clinical suspicion is essential, particularly in patients who have had recent operations on the genito-urinary system.

Hematogenous Vertebral Osteomyelitis Due to Staphylococcus aureus in the Adult: Clinical Features and Therapeutic Outcomes

Staphylococcus aureus is the most common cause of hematogenous vertebral osteomyelitis in adults. To better define clinical features and therapeutic outcomes, the charts of 40 adult patients with S aureus hematogenous vertebral osteomyelitis were retrospectively reviewed. Retrospective chart review using standardized data collection form. S aureus hematogenous vertebral osteomyelitis commonly occurred in the settings of recent invasive procedures (55% of patients), insulin use (28%), and hemodialysis (20%). Ten percent of patients had S aureus bacteremia or vascular catheter infection within the preceding 6 months. Median time from first symptom to diagnosis was 51.3 days. A portal of entry for S aureus was identified in 13 patients (32.5%); intravenous catheters were the likely origin in 9 of those 13 patients. Concurrent endocarditis was present in 4 patients. Forty-eight percent of patients had neurologic abnormalities and 60% of patients had an epidural, paraspinous, or psoas abscess demonstrated by neuroimaging. S aureus was isolated through fine-needle aspiration in 17 of 23 patients (74%) and from blood cultures in 23 of 34 patients (68%). Infection was due to methicillin-susceptible S aureus in 67.5% of patients. All patients received intravenous antibiotics for a mean duration of 58.6 days; 36 of 40 (90%) also received concomitant rifampin. Twenty-seven percent and 12.5% of patients underwent surgical debridement and CT-guided drainage of abscesses, respectively. After intravenous therapy, 19 of 30 eligible patients received oral continuation treatment. The mean duration of total antibiotic therapy was 142.2 days. Cure of infection was achieved in 83% (24/29) of evaluable patients, but 50% of those achieving cure still had infection-related sequelae. Intravenous antibiotic therapy for at least 8 weeks was the only clinical factor associated with cure (P = 0.05, two-tailed Fisher exact test).

DISKITIS IN CHILDREN

Diskitis, inflammation of the intervertebral disk, is an uncommon disease that occurs almost solely in children. It was described as early as 1925 and has been known variously as pyogenic osteomyelitis, benign osteomyelitis, spondylarthritis, and, more recently, diskitis. The incidence of diskitis is not known, but a group of investigators at one institution reported the occurrence of seven cases over 5 years and suggested that the disease is more common than is generally recognized. In my hospital, which handles 30,000 clinic visits and 2,500 postneonatal hospital admissions per year, physicians diagnose 1-2 cases each year. The condition is so uncommon that the relevant literature consists largely of descriptions of small numbers of cases that have occurred over a number of years at a single institution. Various studies include children of different ages, define diskitis differently, and, because of their retrospective nature, lack data that often are crucial. Many study reports offer inadequate followup information. Until prospective studies are performed that strictly adhere to predefined diagnostic criteria, randomized interventions, and systematic long-term follow-ups, the disease will continue to be a creature resembling the elephant described (differently) by blind examiners. Nonetheless, the physician who suspects diskitis in a child must diagnose and manage the case in the context of our current knowledge of the disease, however imperfect. Diskitis in children has been likened to vertebral osteomyelitis in adults. It is true that vertebral osteomyelitis is very rare in young children, but it does occur, and diskitis-although usually a postsurgical condition-occurs spontaneously in adults and follows a course much like that of diskitis in young children. This review focuses on the clinical presentation and evolution, diagnosis and differential diagnosis, and management and outcome of the condition in young children. The reason for this emphasis is that diskitis occurs more commonly among young children than among older children and adults and is associated with a different clinical picture and frequently has a different outcome among the very young (in

Diskitis in children.

Diskitis, inflammation of the intervertebral disk, is an uncommon disease that occurs almost solely in children. It was described as early as 1925 and has been known variously as pyogenic osteomyelitis, benign osteomyelitis, spondylarthritis, and, more recently, diskitis. The incidence of diskitis is not known, but a group of investigators at one institution reported the occurrence of seven cases over 5 years and suggested that the disease is more common than is generally recognized. In my hospital, which handles 30,000 clinic visits and 2,500 postneonatal hospital admissions per year, physicians diagnose 1-2 cases each year. The condition is so uncommon that the relevant literature consists largely of descriptions of small numbers of cases that have occurred over a number of years at a single institution. Various studies include children of different ages, define diskitis differently, and, because of their retrospective nature, lack data that often are crucial. Many study reports offer inadequate followup information. Until prospective studies are performed that strictly adhere to predefined diagnostic criteria, randomized interventions, and systematic long-term follow-ups, the disease will continue to be a creature resembling the elephant described (differently) by blind examiners. Nonetheless, the physician who suspects diskitis in a child must diagnose and manage the case in the context of our current knowledge of the disease, however imperfect. Diskitis in children has been likened to vertebral osteomyelitis in adults. It is true that vertebral osteomyelitis is very rare in young children, but it does occur, and diskitis-although usually a postsurgical condition-occurs spontaneously in adults and follows a course much like that of diskitis in young children. This review focuses on the clinical presentation and evolution, diagnosis and differential diagnosis, and management and outcome of the condition in young children. The reason for this emphasis is that diskitis occurs more commonly among young children than among older children and adults and is associated with a different clinical picture and frequently has a different outcome among the very young (in

Diagnosis and management of pyogenic vertebral osteomyelitis in adults

Management of vertebral osteomyelitis remains controversial regarding optimum duration of antibiotic therapy and the role of surgery. Forty adults with vertebral osteomyelitis were reviewed. Staphylococcus aureus was the most common pathogen isolated. Disk space narrowing with end-plate erosion was the earliest finding, followed by progressive vertebral body destruction. Magnetic resonance imaging proved extremely valuable in detecting spinal cord compression in patients with neurologic deficit. Treatment should include at least 8 weeks of intravenous antibiotics combined with immobilization for pain reduction. Surgical intervention is indicated for all patients with neurologic deficit. Serial erythrocyte sedimentation rates are valuable for following response to therapy. The value of magnetic resonance imaging in diagnosis is emphasized.