Jung N1, Ernst A2, Joost I3, Yagdiran A4, Peyerl-Hoffmann G5, Grau S6, Breuninger M7, Hellmich M2, Kubosch Dc8, Klingler Jh9, Seifert H10, Kern Wv5, Kaasch Aj11, Rieg S5. 1. University of Cologne, Faculty of Medicine, University Clinics, Department I of Internal Medicine, Division of Infectious Diseases, Kerpener Straße 62, Cologne 50937, Germany. Electronic address: norma.jung@uk-koeln.de. 2. Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine, University of Cologne, Cologne 50924, Germany. 3. Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University Düsseldorf, Universitätsstr.1, Düsseldorf 40225, Germany. 4. Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany. 5. Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg 79106, Germany. 6. Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany. 7. University of Cologne, Faculty of Medicine, University Clinics, Department I of Internal Medicine, Division of Infectious Diseases, Kerpener Straße 62, Cologne 50937, Germany. 8. Department of Orthopedics and Trauma Surgery, University Hospital of Freiburg, Freiburg, Germany. 9. Department of Neurosurgery, University Hospital of Freiburg, Freiburg, Germany. 10. Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne 50937, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany. 11. Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Faculty of Medicine, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, Magdeburg 39120, Germany.
Abstract
OBJECTIVES: Staphylococcus aureus is the most common cause of pyogenic vertebral osteomyelitis (VO). Studies indicate that S. aureus VO results in poor outcome. We aimed to investigate risk factors for treatment failure in patients with Staphylococcus aureus bloodstream infection (SAB) and VO. METHODS: We conducted a post hoc-analysis of data from a German bi-center prospective SAB cohort (2006-2014). Patients were followed-up for one year. Primary outcome was treatment failure defined as relapse and/or death within one year. RESULTS: A total of 1069 patients with SAB were analyzed, with 92 VO patients. In addition to antibiotic treatment, surgery was performed in 60/92 patients. Treatment failed in 44/92 patients (death, n = 42; relapse, n = 2). Multivariable analysis revealed higher age (HR 1.04 [per year], 95%CI 1.01-1.07), Charlson comorbidity index (HR 1.20, 95%CI 1.06-1.36), presence of neurologic deficits (HR 2.53, 95%CI 1.15-5.53) and local abscess formation (HR 3.35, 95%CI 1.39-8.04) as independent risk factors for treatment failure. In contrast, surgery seemed to be associated with a favourable outcome (HR 0.45 (95%CI 0.20-0.997)). CONCLUSION: SAB patients with VO exhibit a high treatment failure rate. Red flags are older age, comorbidities, neurologic deficits and local abscess formation. Whether these patients benefit from intensified treatment (e.g. radical surgery, prolongation of antibiotics) should be investigated further. BACKGROUND/ OBJECTIVES: The incidence of vertebral osteomyelitis (VO) has increased over the last years. Estimates from France for 2002/2003 from national hospital-discharge data showed an overall incidence of 2.3/100 000 with an increase with age: 0.3/100 000 (<20 years), 3.5/100 000 (50-70 years) and 6.5/100 000 (>70 years)1. Incidence increased from 2.2 to 5.8 per 100 000 person-years over 1995-2008 in Denmark Kehrer et al. (2014). Likewise in Japan increasing incidences have been reported from 5.3 to 7.4 per 100 000 population per year over 2007-2010 (Akiyama et al. 2013) []. This increase is presumably due to an aging population with chronic comorbidities, a growing number of immunosuppressed patients, invasive procedures in vulnerable populations, and better diagnostics (Kehrer et al. 2014).
OBJECTIVES:Staphylococcus aureus is the most common cause of pyogenic vertebral osteomyelitis (VO). Studies indicate that S. aureus VO results in poor outcome. We aimed to investigate risk factors for treatment failure in patients with Staphylococcus aureus bloodstream infection (SAB) and VO. METHODS: We conducted a post hoc-analysis of data from a German bi-center prospective SAB cohort (2006-2014). Patients were followed-up for one year. Primary outcome was treatment failure defined as relapse and/or death within one year. RESULTS: A total of 1069 patients with SAB were analyzed, with 92 VO patients. In addition to antibiotic treatment, surgery was performed in 60/92 patients. Treatment failed in 44/92 patients (death, n = 42; relapse, n = 2). Multivariable analysis revealed higher age (HR 1.04 [per year], 95%CI 1.01-1.07), Charlson comorbidity index (HR 1.20, 95%CI 1.06-1.36), presence of neurologic deficits (HR 2.53, 95%CI 1.15-5.53) and local abscess formation (HR 3.35, 95%CI 1.39-8.04) as independent risk factors for treatment failure. In contrast, surgery seemed to be associated with a favourable outcome (HR 0.45 (95%CI 0.20-0.997)). CONCLUSION: SAB patients with VO exhibit a high treatment failure rate. Red flags are older age, comorbidities, neurologic deficits and local abscess formation. Whether these patients benefit from intensified treatment (e.g. radical surgery, prolongation of antibiotics) should be investigated further. BACKGROUND/ OBJECTIVES: The incidence of vertebral osteomyelitis (VO) has increased over the last years. Estimates from France for 2002/2003 from national hospital-discharge data showed an overall incidence of 2.3/100 000 with an increase with age: 0.3/100 000 (<20 years), 3.5/100 000 (50-70 years) and 6.5/100 000 (>70 years)1. Incidence increased from 2.2 to 5.8 per 100 000 person-years over 1995-2008 in Denmark Kehrer et al. (2014). Likewise in Japan increasing incidences have been reported from 5.3 to 7.4 per 100 000 population per year over 2007-2010 (Akiyama et al. 2013) []. This increase is presumably due to an aging population with chronic comorbidities, a growing number of immunosuppressed patients, invasive procedures in vulnerable populations, and better diagnostics (Kehrer et al. 2014).
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