Health Care Associated Hematogenous Pyogenic Vertebral Osteomyelitis

Abstract

Although hematogenous pyogenic spinal infections have been related to hemodialysis (HD), catheter-related sepsis, and sporadically, to other nosocomial infections or procedures, in most recent studies and reviews the impact of nosocomial infection as a risk factor for vertebral osteomyelitis (VO) is not well established. The aim of our study was to describe the risk factors, infectious source, etiology, clinical features, therapy, and outcome of health care associated VO (HCAVO), and compare them with community-acquired VO (CAVO) cases.A retrospective cohort study of consecutive patients with hematogenous VO was conducted in our third-level hospital between 1987 and 2011. HCAVO was defined as onset of symptoms after 1 month of hospitalization or within 6 months after hospital discharge, or ambulatory manipulations in the 6 months before the diagnosis.Over the 25-year study period, among 163 hematogenous pyogenic VO, 41 (25%) were health care associated, a percentage that increased from 15% (9/61) in the 1987–1999 period to 31% (32/102) in the 2000–2011 period (P < 0.01). The presumed source of infection was an intravenous catheter in 14 (34%), cutaneous foci in 8 (20%), urinary tract in 7 (17%), gastrointestinal in 3 (7%), other foci in 3 (7%), and unknown in 6 (15%). Staphylococcus aureus was the most frequently isolated microorganism (14 cases, 34%), followed by coagulase-negative Staphylococci (CoNS) in 6 (15%), and Enterobacteriaceae in 6 (15%) cases.Compared with CAVO cases, patients with HCAVO were older (mean 66.0 SD 13.0 years vs 60.5 SD 15.5 years), had more underlying conditions (73% vs 50%, P < 0.05), neoplasm/immunosuppression (39% vs 7%, P < 0.005), chronic renal failure (19% vs 4%, P < 0.001), a known source of infection (85% vs 54% P < 0.05), Candida spp (7% vs 0%, P < 0.01) or CoNS infections (15% vs 2%, P < 0.05), higher mortality (15% vs 6%, P = 0.069), and a higher relapse rate in survivors (9% vs 1%, P < 0.05).Presently, in our setting, one-third of hematogenous pyogenic VO infections are health care associated, and a third of these are potentially preventable catheter-related infections. Compared with CAVO, in health care associated hematogenous VO, mortality and relapse rates are higher; hence, further prevention measures should be assessed.

Spinal Infections: An Update

“…Although spinal infections can affect patients of any age starting from infancy, vertebral spondylodiscitis most commonly occurs in adults and has a predilection for patients aged >50 years; intravenous drug abusers are a younger age group with high susceptibility to spinal infections [8,9]. There are several factors that can possibly explain the higher prevalence of spinal infections in older people including immunosuppressive medications, intravascular devices, and other forms of implants that are more common in older patients [10].…”

Espondilodiscitis: experiencia clínica en un hospital general de Chile

“…Nuestra serie confirma que las manifestaciones clínicas más relevantes fueron el dolor axial, la fiebre y los síntomas neurológicos, hallazgos constantemente presente en múltiples series 5,7,11,12 . Del total de las ED, se describe hasta 25% de adquisición nosocomial o asociado a atención en salud, la mayoría por inoculación directa posterior a una cirugía de columna, en pacientes con más co-morbilidades, y con mayor riesgo de complicaciones, recaídas y mortalidad 2,18 . La PCR y la VHS estuvieron elevadas en la mayorías de los pacientes, mientras que sólo aproximadamente un tercio presentó leucocitosis.…”

“…En una serie nacional de 18 casos, el estudio cintigráfico mostró actividad osteoblástica en 100% de los casos 7 . Estos resultados son concordantes con la alta sensibilidad observada en esta serie (94%), lo que convierte a la cintigrafía en un método imagenológico útil ante la sospecha de ED, incluyendo aquellas que llevan pocos días de evolución clínica [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . La TAC ofrece una menor sensibilidad respecto a los métodos cintigráficos, pero permite evaluar con mayor precisión la existencia de colecciones, el grado de destrucción vertebral, otras complicaciones, y facilita la evaluación de la estabilidad de la columna.…”

Febrile Syndrome in the Diabetic Adult, A Diagnostic Trap

“…50% of the cases diagnosed with (8) spondylodiscitis in the general population are caused by the infection with Staphylococcus aureus by way of blood-borne infections mostly . Diagnosing spondylodiscitis is a real (9)(10)(11) challenge in practice, because the initial symptomatology can be represented by pain that subsides with rest -pain that is almost typical with the most common rheumatologic disorder in the elderly -arthrosis. The pain gradually increases within weeks, even months up to the moment of diagnosis .…”