Microbial Etiology of Pyogenic Vertebral Osteomyelitis According to Patient Characteristics

Abstract

Background It is difficult to select an appropriate empirical antibiotic treatment regimen for patients with culture-negative pyogenic vertebral osteomyelitis (PVO). Having knowledge of the distribution of microorganisms according to patient characteristics can help clinicians make informed choices regarding empirical antibiotics. The aim of this study was to determine the microbial distribution among individuals with PVO according to their demographic and clinical characteristics. Methods We reviewed the medical records of patients admitted to our hospital with culture-confirmed PVO between January 2005 and December 2017 and collected data on demographics, underlying diseases, and radiographic and microbiological results. Statistical analysis was performed to identify associations between specific bacteria and specific patient characteristics. Results A total of 586 patients were included in the study. The prevalence of Staphylococcus aureus infections was higher in young patients than in old patients, while gram-negative bacterial infections and Enterococcus were more prevalent in older patients. Gram-negative bacterial infections were more common in women than in men (32.1% vs 16.4%; P < .05), in patients with cirrhosis than in those without (32.7% vs 21.1%; P < .05), and in patients with a solid tumor than in those without (31.0% vs 20.7%; P < .05). Methicillin-resistant S. aureus infections were more prevalent in patients with chronic renal disease than in those without (34.4% vs 14.7%; P < .05). Conclusions The microbial etiology of PVO varies according to patient characteristics. Patient characteristics should thus be considered when choosing empirical antibiotics in patients with culture-negative PVO.

Clinical characteristics of pyogenic vertebral osteomyelitis, and factors associated with inadequate treatment response

“…In accordance with other studies, the majority of our PVO population was found to consist of elderly men presenting with back pain and elevated CRP (Chang et al, 2018;Chong et al, 2018;Jeon et al, 2020;Kim et al, 2020;Vettivel et al, 2019). These findings were consistent with a previous study from our institution by Aagaard et al, using a similar design, on 100 PVO patients admitted from 2006 to 2011 (Aagaard et al, 2013).…”

“…In general, our study reported similar demographics and comorbidities to those in previous reports (Chong et al, 2018;Jeon et al, 2020;Kim et al, 2020;Lee et al, 2019).…”

“…Seeding of pathogens from previous surgery could explain an association with ITR if empiric antibiotic regimes used in the earlier treatments were insufficient to control pathogens associated with previous spinal surgery. Earlier studies comparing postoperative PVO with native PVO have shown different distributions of bacteria causing infection, with coagulasenegative Staphylococcus and MRSA being more frequent in the postoperative population (Breuninger et al, 2020;Kim et al, 2019bKim et al, , 2020. However, our rates of these pathogens were low and did not seem to be overrepresented in the ITR group, reducing the likelihood of this causation.…”

Gram-negative Versus Gram-positive in Primary Pyogenic Spondylitis and Analysis of Risk Factors for Relapse

“…Diabetes is the most common underlying disease, although there are reports that pyogenic spondylitis caused by Gram-negative bacteria is related to diabetes [15]. However, our study and Dong Youn Kim et al [16] did not nd any connection between these two factors.…”

Causative Pathogens and Antibiotic Resistance in Infectious Arthritis

“…This finding is similar to that reported by a previous domestic study in which MRSA was identified as the causative agent in 44% of the overall cases of S. aureus osteoarticular infections [ 3 ]. MRSA has also been reported to be the causative agent in 38 - 43% cases of native vertebral osteomyelitis in Korea [ 4 5 ]. Lee et al showed that a high MRSA ratio was associated with high resistance rates to ciprofloxacin (34.3%) and clindamycin (42.9%) in cases of S. aureus infection [ 2 ].…”