Matthew Koslow1, Rafael Kuperstein2, Iris Eshed3, Marina Perelman4, Elad Maor2, Yechezkel Sidi5. 1. Department of Internal Medicine C, Chaim Sheba Medical Center, Tel Hashomer, Israel; Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel. Electronic address: mkoslow73@gmail.com. 2. Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel; Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel. 3. Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel; Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel. 4. Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel; Department of Pathology, Chaim Sheba Medical Center, Tel Hashomer, Israel. 5. Department of Internal Medicine C, Chaim Sheba Medical Center, Tel Hashomer, Israel; Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel.
Abstract
OBJECTIVE: The clinical significance of vertebral osteomyelitis and infectious endocarditis co-infection is unclear. This study investigates the rate, clinical features, and outcome of vertebral osteomyelitis with and without concomitant infectious endocarditis. METHODS: A retrospective study of all cases of osteomyelitis with spinal imaging (n = 176), from January 2007 to April 2013, that were diagnosed as vertebral osteomyelitis. Sixty-two patients with spontaneous vertebral osteomyelitis were identified after excluding postsurgical, decubitus ulcers and spinal metastases. Seventeen (27%) were identified with concomitant infectious endocarditis. RESULTS: All patients presented with back pain and 59% were diagnosed with infectious endocarditis subsequent to vertebral osteomyelitis. Distinguishing features among the co-infection group include the increased use of transesophageal echocardiography (94% vs 58%, P = .004), predisposing cardiac conditions (59% vs 16%, P = .001), and Gram-positive bacteremia, of which Streptococcus sp. and Enterococcus sp. were more common (35% vs 11%, P = .026). Adverse neurologic events were increased significantly in the co-infection group (59% vs 22%, P = .006). On transesophageal echocardiography, 88% of co-infection patients had highly mobile vegetations, 9 of which measured 10 mm or more. The overall mortality was 41% and 29% in the co-infection and lone vertebral osteomyelitis groups, respectively (P = .356). One-year mortality was identical for both groups at 24% (P = .999), and higher than previously reported (11.3% for lone vertebral osteomyelitis). CONCLUSIONS: Patients with vertebral osteomyelitis, in whom infectious endocarditis is not excluded, are at increased risk for adverse neurologic events and mortality. The prompt diagnosis of infectious endocarditis, and associated high-risk features that may benefit from surgical intervention, require early evaluation by transesophageal echocardiography.
OBJECTIVE: The clinical significance of vertebral osteomyelitis and infectious endocarditis co-infection is unclear. This study investigates the rate, clinical features, and outcome of vertebral osteomyelitis with and without concomitant infectious endocarditis. METHODS: A retrospective study of all cases of osteomyelitis with spinal imaging (n = 176), from January 2007 to April 2013, that were diagnosed as vertebral osteomyelitis. Sixty-two patients with spontaneous vertebral osteomyelitis were identified after excluding postsurgical, decubitus ulcers and spinal metastases. Seventeen (27%) were identified with concomitant infectious endocarditis. RESULTS: All patients presented with back pain and 59% were diagnosed with infectious endocarditis subsequent to vertebral osteomyelitis. Distinguishing features among the co-infection group include the increased use of transesophageal echocardiography (94% vs 58%, P = .004), predisposing cardiac conditions (59% vs 16%, P = .001), and Gram-positive bacteremia, of which Streptococcus sp. and Enterococcus sp. were more common (35% vs 11%, P = .026). Adverse neurologic events were increased significantly in the co-infection group (59% vs 22%, P = .006). On transesophageal echocardiography, 88% of co-infection patients had highly mobile vegetations, 9 of which measured 10 mm or more. The overall mortality was 41% and 29% in the co-infection and lone vertebral osteomyelitis groups, respectively (P = .356). One-year mortality was identical for both groups at 24% (P = .999), and higher than previously reported (11.3% for lone vertebral osteomyelitis). CONCLUSIONS:Patients with vertebral osteomyelitis, in whom infectious endocarditis is not excluded, are at increased risk for adverse neurologic events and mortality. The prompt diagnosis of infectious endocarditis, and associated high-risk features that may benefit from surgical intervention, require early evaluation by transesophageal echocardiography.
Authors: Elena Lazzeri; Alessandro Bozzao; Maria Adriana Cataldo; Nicola Petrosillo; Luigi Manfrè; Andrej Trampuz; Alberto Signore; Mario Muto Journal: Eur J Nucl Med Mol Imaging Date: 2019-08-09 Impact factor: 9.236
Authors: Johan Courjon; Adrien Lemaignen; Idir Ghout; Audrey Therby; Nadia Belmatoug; Aurélien Dinh; Guillaume Gras; Louis Bernard Journal: PLoS One Date: 2017-12-05 Impact factor: 3.240