Clinical Differences Between Monomicrobial and Polymicrobial Vertebral Osteomyelitis

Issa, Kimona; Pourtaheri, Sina; Stewart, Tyler N.; Faloon, Michael; Sahai, Nikhil; Mease, Samuel J.; Sinha, Kumar; Hwang, Ki Soo; Emami, Arash

doi:10.3928/01477447-20161108-05

Cited by 8 publications

(9 citation statements)

References 21 publications

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“…Oftentimes, polymicrobial infections are associated with poorer outcomes and increased infection severity 79 . This can be explained by microbial synergism that induces specific virulence traits or modulates the host immune response 80 .…”

Section: Polymicrobial Infectionsmentioning

confidence: 99%

Skeletal infections: microbial pathogenesis, immunity and clinical management

et al. 2022

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Osteomyelitis is an infection of bone that can result from contiguous spread from surrounding tissue, direct bone trauma due to surgery or injury, or haematogenous spread from systemic bacteraemia. It remains a significant health-care burden with a prevalence of ~22 cases per 100,000 person-years in the United States, and its incidence has been rising over time, especially in the elderly and individuals with diabetes 1 . Although it is a heterogeneous disease, subset classifications include implant-associated osteomyelitis (including peri-prosthetic joint infection (PJI) and instrumented spinal infections), fracture-related infection, acute haematogenous osteomyelitis, diabetic foot infection, septic arthritis and native spinal osteomyelitis.Crucial to expanding our understanding of osteomyelitis and advancing treatment algorithms has been the application of animal models, which illustrate the interaction between the pathogen and cells of both the immune and skeletal systems in a manner that in vitro models cannot yet replicate. Animal models are available to study virtually all aspects of skeletal infection, and typically involve inoculation of bacteria at the time of implant placement (Fig. 1). They can vary in complexity from simple models where metal implants are placed under the skin (for example, tissue cage 2 ) or into cortical bone (for example, metal wire 3 ) versus more complex models that mimic functional orthopaedic devices 4 . Additionally, approaches have been developed to induce non-implant infections by haematogenous inoculation into the tail vein 5 , direct inoculation into vertebral bodies or intervertebral discs 6 to induce vertebral osteomyelitis, or inoculation into the foot pad of diabetic obese rodents to induce diabetic foot infection 7 .As disease pathogenesis differs across different infection classes, so does microbial aetiology. Many different microorganisms have been implicated in skeletal infection, and the most common, along with their incidence and tropism, are shown in Table 1. In general, Staphylococcus aureus and coagulase-negative staphylococci (CoNS), such as Staphylococcus epidermidis and Staphylococcus lugdunensis, are responsible for up to two-thirds of all skeletal infections, with S. aureus being the most prevalent single pathogen. Additionally, antimicrobial resistance remains a challenge in osteomyelitis treatment with up to 50% of cases of S. aureus osteomyelitis caused by methicillin-resistant S. aureus (MRSA) strains 8 . Other less commonly identified pathogens include Enterococcus spp., Pseudomonas aeruginosa, Escherichia coli and Cutibacterium acnes (Table 1). Most cases of osteomyelitis are monomicrobial; however,

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Section: Polymicrobial Infectionsmentioning

confidence: 99%

Skeletal infections: microbial pathogenesis, immunity and clinical management

et al. 2022

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“…Polymicrobial infection is rarer and typically ordinarily due to a contiguous spread that includes participation of anaerobes as a general rule [ 10 ]. This presents with differences in presentation and clinical outcomes from monomicrobial vertebral osteomyelitis [ 13 ].…”

Section: Pathophysiologymentioning

confidence: 99%

“…Late diagnosis can lead to general multiple organ failure and epidural abscesses [ 23 ]. Early diagnosis has improved VO clearance and clinical outcomes but is also held back by the fact that 30-70% of patients with VO show no signs of prior infection [ 13 ]. As a result, diagnosis should be supported by a combination of history and physical examination, laboratory data, clinical findings, and proper imaging, as to allow the clinician to reach a reasonable index of suspicion [ 21 ].…”

Section: Diagnosismentioning

confidence: 99%

Osteomyelitis of the spine: treatments and future directions

Mehkri¹,

Felisma²,

Panther³

et al. 2022

Infect Dis Res

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Background: Osteomyelitis of the spine is a serious condition that has been increasing with the intravenous drug pandemic and aging population. Multiple different organisms can cause osteomyelitis and mainstay of treatment is early recognition and antibiotics. The course can sometimes be indolent leading to delayed presentations. Once suspected, comprehensive workup and initiation of management should be employed. In rare circumstances, surgical evacuation or deformity correction is indicated. Continued antibiotic treatment should be considered post-operatively. Methods: Emerging treatment solutions are being developed to help target osteomyelitis in a more effective manner. In this review, we highlight the epidemiology and pathophysiology of spinal osteomyelitis. We overview the diagnostic workup and treatment options. Finally, we present new options that are currently being investigated and are on the near horizon. Conclusion: This review offers a user friendly resource for clinicians and researchers regarding osteomyelitis of the spine and will serve as a catalyst for further discovery.

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“…In cases of unambiguous progression of infection, one potential consideration for treatment failure is polymicrobial infection (fig 13). Polymicrobial infections are associated with older age and higher mortality 44 . However, incidence data and clinical significance of polymicrobial spine infections are sparse.…”

Section: Special Considerationsmentioning

confidence: 99%

“…Therefore, in cases of treatment failure, polymicrobial infection should be considered. Further study of the clinical significance of polymicrobial infection is warranted 44 .…”

Section: Special Considerationsmentioning

confidence: 99%