Yu-Mi Lee1, Oh-Hyun Cho2, Seong Yeon Park3, Chisook Moon4, Yong Pil Chong5, Sung-Han Kim5, Sang-Oh Lee5, Sang-Ho Choi5, Mi Suk Lee1, In-Gyu Bae2, Yang Soo Kim5, Jun Hee Woo5, Kyung-Chung Kang6, Jung-Hee Lee6, Ki-Ho Park7. 1. Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea. 2. Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea. 3. Division of Infectious Diseases, Department of Internal Medicine, Dongguk University Ilsan Hospital, University of Dongguk College of Medicine, Goyang-si, Republic of Korea. 4. Department of Infectious Diseases, Busan Paik Hospital, Inje University College of Medicine, Busan. 5. Department of Infectious Diseases, Asan Medical Center, University of Ulsan college of Medicine, Seoul, Republic of Korea. 6. Department of Orthopaedic Surgery, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea. 7. Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea. Electronic address: parkkiho@hotmail.com.
Abstract
OBJECTIVES: Functional disability may persist after completing treatment for hematogenous pyogenic vertebral osteomyelitis (HPVO). The objective of this study was to identify factors associated with residual sequelae after treatment of HPVO. METHODS: We conducted a retrospective study of patients diagnosed with HPVO at 5 tertiary-care hospitals between January 2005 and December 2012. Sequelae were defined as an inability to walk without assistance, bladder/bowel incontinence, and/or unresolved pain that required analgesic therapy at 12 months after completing the HPVO treatment. RESULTS: Of the 279 patients with microbiologically proven HPVO, 79 (28.3%) had sequelae at 12 months posttherapy. Independent risk factors for sequelae were neurologic deficit (adjusted odds ratio [aOR], 3.38), recurrence within 12 months (aOR, 2.45), age ≥ 65 years (aOR, 2.05), C-reactive protein level ≥ 10 mg/dL (aOR, 2.01), and epidural/paravertebral abscess (aOR, 2.00). Among 58 patients with neurologic deficit, sequelae rates differed according to the surgical strategy, as follows: 28.6% (early surgery [<48 h]), 55.0% (delayed surgery [≥48 h]), and 66.7% (no surgery) (P = 0.03). Among the 170 patients with abscess, early drainage (<72 h) was an independent protective factor for sequelae (aOR, 0.35). The 12-month recurrence rates differed according to the total duration of antibiotic treatment, as follows: 20.5% (4-6 weeks), 18.4% (6-8 weeks), and 5.2% (≥8 weeks) (P < 0.001). CONCLUSIONS: A substantial proportion of patients with HPVO experienced sequelae after completing treatment. Early surgery for neurologic deficit, early drainage of abscess, and antibiotic therapy of appropriate duration to reduce recurrence may prevent development of sequelae in patients with HPVO.
OBJECTIVES: Functional disability may persist after completing treatment for hematogenous pyogenic vertebral osteomyelitis (HPVO). The objective of this study was to identify factors associated with residual sequelae after treatment of HPVO. METHODS: We conducted a retrospective study of patients diagnosed with HPVO at 5 tertiary-care hospitals between January 2005 and December 2012. Sequelae were defined as an inability to walk without assistance, bladder/bowel incontinence, and/or unresolved pain that required analgesic therapy at 12 months after completing the HPVO treatment. RESULTS: Of the 279 patients with microbiologically proven HPVO, 79 (28.3%) had sequelae at 12 months posttherapy. Independent risk factors for sequelae were neurologic deficit (adjusted odds ratio [aOR], 3.38), recurrence within 12 months (aOR, 2.45), age ≥ 65 years (aOR, 2.05), C-reactive protein level ≥ 10 mg/dL (aOR, 2.01), and epidural/paravertebral abscess (aOR, 2.00). Among 58 patients with neurologic deficit, sequelae rates differed according to the surgical strategy, as follows: 28.6% (early surgery [<48 h]), 55.0% (delayed surgery [≥48 h]), and 66.7% (no surgery) (P = 0.03). Among the 170 patients with abscess, early drainage (<72 h) was an independent protective factor for sequelae (aOR, 0.35). The 12-month recurrence rates differed according to the total duration of antibiotic treatment, as follows: 20.5% (4-6 weeks), 18.4% (6-8 weeks), and 5.2% (≥8 weeks) (P < 0.001). CONCLUSIONS: A substantial proportion of patients with HPVO experienced sequelae after completing treatment. Early surgery for neurologic deficit, early drainage of abscess, and antibiotic therapy of appropriate duration to reduce recurrence may prevent development of sequelae in patients with HPVO.
Authors: A Yagdiran; C Otto-Lambertz; B Sondermann; A Ernst; D Jochimsen; R Sobottke; J Siewe; P Eysel; N Jung Journal: Arch Orthop Trauma Surg Date: 2022-03-31 Impact factor: 3.067
Authors: Thomas K Fehring; Keith A Fehring; Angela Hewlett; Carlos A Higuera; Jesse E Otero; Aaron J Tande Journal: J Bone Joint Surg Am Date: 2020-07-15 Impact factor: 6.558