Jungok Kim1, Yeon-Sook Kim2, Kyong Ran Peck3, Eun-Sang Kim4, Sun Young Cho5, Young Eun Ha5, Cheol-In Kang5, Doo Ryeon Chung5, Jae-Hoon Song5. 1. Division of Infectious Diseases, Sejong General Hospital, Seoul, South Korea. 2. Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea. 3. Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea. Electronic address: krpeck@skku.edu. 4. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 5. Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea.
Abstract
OBJECTIVES: Although pyogenic vertebral osteomyelitis (PVO) with no identified microorganism is treated empirically, the clinical outcome is not well understood. METHODS: We conducted a retrospective review of patients with PVO at a tertiary-care hospital from 2000 through 2012. The study compared clinical features and outcomes of microbiologically confirmed (M-PVO) with clinically diagnosed PVO (C-PVO). RESULTS: Of 151 patients with PVO, 75 (49.7%) had M-PVO. Compared to patients with M-PVO, patients with C-PVO had fewer underlying medical conditions. In addition, they presented less frequently with fever, high acute-phase reactants levels, and paraspinal abscess. The rate of treatment failure tended to be lower in the C-PVO group [9.2% (7/76) vs. 17.3% (13/75); p = 0.157]. The overall relapse rate was 6.6% and did not differ significantly between groups; notably this rate was higher in patients who received antibiotics for ≤ 6 weeks [18.8% (3/16)] and ≤ 8 weeks [12.1% (4/33)]. The independent risk factors for treatment failure were higher CRP levels [odds ratio (OR) = 1.087; 95% confidence interval (CI): 1.025-1.153; p = 0.005] and fever ≥ 37.8°C (OR = 8.556; 95% CI: 2.273-32.207; p = 0.002). CONCLUSIONS: Patients with C-PVO had less systemic inflammatory response and a more favorable outcome compared to M-PVO. Prolonged antibiotic therapy, for at least 8 weeks, might be required for C-PVO, as well as for M-PVO until better outcomes are assured.
OBJECTIVES: Although pyogenic vertebral osteomyelitis (PVO) with no identified microorganism is treated empirically, the clinical outcome is not well understood. METHODS: We conducted a retrospective review of patients with PVO at a tertiary-care hospital from 2000 through 2012. The study compared clinical features and outcomes of microbiologically confirmed (M-PVO) with clinically diagnosed PVO (C-PVO). RESULTS: Of 151 patients with PVO, 75 (49.7%) had M-PVO. Compared to patients with M-PVO, patients with C-PVO had fewer underlying medical conditions. In addition, they presented less frequently with fever, high acute-phase reactants levels, and paraspinal abscess. The rate of treatment failure tended to be lower in the C-PVO group [9.2% (7/76) vs. 17.3% (13/75); p = 0.157]. The overall relapse rate was 6.6% and did not differ significantly between groups; notably this rate was higher in patients who received antibiotics for ≤ 6 weeks [18.8% (3/16)] and ≤ 8 weeks [12.1% (4/33)]. The independent risk factors for treatment failure were higher CRP levels [odds ratio (OR) = 1.087; 95% confidence interval (CI): 1.025-1.153; p = 0.005] and fever ≥ 37.8°C (OR = 8.556; 95% CI: 2.273-32.207; p = 0.002). CONCLUSIONS:Patients with C-PVO had less systemic inflammatory response and a more favorable outcome compared to M-PVO. Prolonged antibiotic therapy, for at least 8 weeks, might be required for C-PVO, as well as for M-PVO until better outcomes are assured.
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