Ki-Ho Park1, Yong Pil Chong, Sung-Han Kim, Sang-Oh Lee, Sang-Ho Choi, Mi Suk Lee, Jin-Yong Jeong, Jun Hee Woo, Yang Soo Kim. 1. Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea; Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea.
Abstract
OBJECTIVE: To evaluate the clinical characteristics and therapeutic outcomes of patients with hematogenous vertebral osteomyelitis (HVO) caused by methicillin-resistant Staphylococcus aureus (MRSA). METHODS: We performed a cohort study of adult patients diagnosed with S. aureus HVO at a tertiary-care hospital over a 7-year period. RESULTS: Of the 139 patients with S. aureus HVO, MRSA caused 62 (44.6%) cases. In multivariate analysis, compared with methicillin-susceptible S. aureus (MSSA), MRSA was associated with a higher risk of persistent bacteremia (≥7 days) (8.40 fold; P < 0.001) and relapse (4.83 fold; P = 0.03), and increased hospital stay (1.69 fold; P = 0.001). Among the MRSA cases, relapse rates differed according to duration of antibiotics: 41.7% (4-6 weeks), 25.0% (6-8 weeks), and 5.6% (≥8 weeks) (P = 0.007). Bacteremia was more likely to persist for ≥7 days in patients with an initial vancomycin trough <15 mg/L than in those with an initial trough ≥15 mg/L (79.3% vs. 20.0%; P = 0.001). CONCLUSIONS: MRSA HVO was associated with more frequent persistent bacteremia (≥7 days) and relapse, and longer hospital stay compared to MSSA HVO. Antibiotic therapy for ≥8 weeks and targeting a vancomycin trough of ≥15 mg/L may be benefit patients with MRSA HVO.
OBJECTIVE: To evaluate the clinical characteristics and therapeutic outcomes of patients with hematogenous vertebral osteomyelitis (HVO) caused by methicillin-resistant Staphylococcus aureus (MRSA). METHODS: We performed a cohort study of adult patients diagnosed with S. aureus HVO at a tertiary-care hospital over a 7-year period. RESULTS: Of the 139 patients with S. aureus HVO, MRSA caused 62 (44.6%) cases. In multivariate analysis, compared with methicillin-susceptible S. aureus (MSSA), MRSA was associated with a higher risk of persistent bacteremia (≥7 days) (8.40 fold; P < 0.001) and relapse (4.83 fold; P = 0.03), and increased hospital stay (1.69 fold; P = 0.001). Among the MRSA cases, relapse rates differed according to duration of antibiotics: 41.7% (4-6 weeks), 25.0% (6-8 weeks), and 5.6% (≥8 weeks) (P = 0.007). Bacteremia was more likely to persist for ≥7 days in patients with an initial vancomycin trough <15 mg/L than in those with an initial trough ≥15 mg/L (79.3% vs. 20.0%; P = 0.001). CONCLUSIONS: MRSA HVO was associated with more frequent persistent bacteremia (≥7 days) and relapse, and longer hospital stay compared to MSSA HVO. Antibiotic therapy for ≥8 weeks and targeting a vancomycin trough of ≥15 mg/L may be benefit patients with MRSA HVO.
Authors: Ryan Arnold; Clare Rock; Lindsay Croft; Bruce L Gilliam; Daniel J Morgan Journal: Antimicrob Agents Chemother Date: 2014-11 Impact factor: 5.191
Authors: Ram Venkatesh Anantha; Januvi Jegatheswaran; Daniel Luke Pepe; Fran Priestap; Johan Delport; S M Mansour Haeryfar; John K McCormick; Tina Mele Journal: CMAJ Open Date: 2014-10-01
Authors: M Loibl; L Stoyanov; C Doenitz; A Brawanski; P Wiggermann; W Krutsch; M Nerlich; M Oszwald; C Neumann; B Salzberger; F Hanses Journal: Infection Date: 2014-01-21 Impact factor: 3.553
Authors: Basem Ishak; Amir Abdul-Jabbar; Gregory B Moss; Emre Yilmaz; Alexander von Glinski; Sven Frieler; Andreas W Unterberg; Ronan Blecher; Juan Altafulla; Jeffrey Roh; Robert A Hart; Rod J Oskouian; Jens R Chapman Journal: Neurosurg Rev Date: 2020-08-27 Impact factor: 3.042