Nora Renz1, Judith Haupenthal2, Michael A Schuetz2, Andrej Trampuz3. 1. Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, D-10117 Berlin, Germany; Berlin Institute of Health, Berlin, Kapelle-Ufer 2, D-10117 Berlin, Germany. Electronic address: nora.renz@charite.de. 2. Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, D-10117 Berlin, Germany. 3. Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, D-10117 Berlin, Germany; Berlin Institute of Health, Berlin, Kapelle-Ufer 2, D-10117 Berlin, Germany.
Abstract
INTRODUCTION: Aim of the study was to investigate the clinical, microbiological, radiological, and treatment characteristics of hematogenous vertebral osteomyelitis originating from infected intravascular devices. PATIENTS AND METHODS: Patients with secondary hematogenous vertebral osteomyelitis caused by an infected intravascular device were included in this retrospective cohort study. Patients with prior spinal surgery were excluded. Categorical variables were compared using χ2 or Fisher's exact tests and continuous variables using the Mann-Whitney U test. RESULTS: Sixty-seven patients with hematogenous vertebral osteomyelitis were included. Intravenous catheters were the source of infection in 45 patients (67%) and cardiovascular devices in 22 (33%). Fever was present in 21 patients (45%). The main pathogens were coagulase-negative staphylococci, isolated in 42 patients (63%), which grew from blood culture in 52 patients (87%), from vertebral tissue in 29 patients (56%) and from the explanted intravascular device in 18 patients (60%), where it was sampled. Infective endocarditis was diagnosed in 14 of 45 patients (31%), more common with cardiovascular devices than with intravascular catheters (56% versus 15%; P=0.008). CONCLUSIONS: In patients with vertebral osteomyelitis, growth of coagulase-negative staphylococci in blood is highly suggestive for intravascular device-associated infection. Despite absence of systemic or local signs of inflammation at the site of the device, blood cultures should be collected and echocardiography performed in these patients.
INTRODUCTION: Aim of the study was to investigate the clinical, microbiological, radiological, and treatment characteristics of hematogenous vertebral osteomyelitis originating from infected intravascular devices. PATIENTS AND METHODS: Patients with secondary hematogenous vertebral osteomyelitis caused by an infected intravascular device were included in this retrospective cohort study. Patients with prior spinal surgery were excluded. Categorical variables were compared using χ2 or Fisher's exact tests and continuous variables using the Mann-Whitney U test. RESULTS: Sixty-seven patients with hematogenous vertebral osteomyelitis were included. Intravenous catheters were the source of infection in 45 patients (67%) and cardiovascular devices in 22 (33%). Fever was present in 21 patients (45%). The main pathogens were coagulase-negative staphylococci, isolated in 42 patients (63%), which grew from blood culture in 52 patients (87%), from vertebral tissue in 29 patients (56%) and from the explanted intravascular device in 18 patients (60%), where it was sampled. Infective endocarditis was diagnosed in 14 of 45 patients (31%), more common with cardiovascular devices than with intravascular catheters (56% versus 15%; P=0.008). CONCLUSIONS: In patients with vertebral osteomyelitis, growth of coagulase-negative staphylococci in blood is highly suggestive for intravascular device-associated infection. Despite absence of systemic or local signs of inflammation at the site of the device, blood cultures should be collected and echocardiography performed in these patients.
Authors: Binjie Xu; Qiuhua Wei; M Ryan Mettetal; Jie Han; Lindsey Rau; Jinfeng Tie; Rhea M May; Eric T Pathe; Shravanthi T Reddy; Lauren Sullivan; Albert E Parker; Donald H Maul; Anthony B Brennan; Ethan E Mann Journal: J Med Microbiol Date: 2017-10-06 Impact factor: 2.472