Microbiological diagnosis of suspected vertebral osteomyelitis with a focus on the yield of percutaneous needle biopsy: a 10-year cohort study

Avenel, Gilles; Guyader, Pauline; Fiaux, E.; Alcaix, D.; Zarnitsky, Charles; Pouplin-Jardin, Sophie; Kozyreff-Meurice, M.; Lequerré, Thierry; Vittecoq, Olivier

doi:10.1007/s10096-020-04022-3

Cited by 8 publications

(3 citation statements)

References 26 publications

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“…The microbiologically confirmed VO rate remained stable as compared to the previous studies using PMSI [ 2 , 4 ], even with the SPILF guidelines recommending a more active seeking for microbiological diagnosis. Other European studies found the same stability of microbiologically confirmed VOs over recent years [ 10 , 21 ].…”

Section: Discussionsupporting

confidence: 64%

Large increase of vertebral osteomyelitis in France: a 2010–2019 cross-sectional study

et al. 2021

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Vertebral osteomyelitis (VO) represents 4 to 10% of bone and joint infections. In Western countries, its incidence seems to increase, simultaneously with an increasing number of comorbidities among an ageing population. This study aimed to assess the evolution of VO epidemiology in France over the 2010-2019 decade. A nationwide cross-sectional study was conducted using the French hospital discharge data collected through the French diagnosisrelated groups "Programme de Médicalisation des Systèmes d'Information". VOs were detected with a previously validated case definition using ICD-10 codes, implemented with the French current procedural terminology codes. The study population included all patients hospitalized in France during the 2010-2019 decade, aged 15 years old and more. Patient and hospital stay characteristics and their evolutions were described. During the study period, 42105 patients were hospitalized for VO in France involving 60878 hospital stays. Mean VO incidence was 7.8/100000 over the study period, increasing from 6.1/100000 in 2010 to 11.3/100000 in 2019.Mean age was 64.8 years old and sex ratio was 1.56. There were 31341 (74.4%) patients with at least one comorbidity and 3059 (7.3%) deceased during their hospital stay. Even if rare, device-associated VOs (4450 hospital stays, 7.3%) highly increased over the period. The reliability of the method, based upon an exhaustive database and a validated case definition, provided an effective tool to compare data over time in real-life conditions to regularly update the epidemiology of VO.

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Section: Discussionsupporting

confidence: 64%

Large increase of vertebral osteomyelitis in France: a 2010–2019 cross-sectional study

et al. 2021

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“…Vertebral biopsies, CT-guided or surgical, can document almost all anaerobic cases of vertebral osteomyelitis. Interestingly, previous antibiotic intake was shown as the only predictor for vertebral biopsy negativity [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Bacteroides fragilis Bacteremia Complicated by Spondylodiscitis, Spinal Epidural Abscess, and Sepsis: A Case Report

et al. 2022

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Patient: Male, 63-year-old Final Diagnosis: Spondylodiscitis, spinal epidural abscess and sepsis as a complication of Bacteroides fragilis bacteraemia Symptoms: Fever and altered level of consciousness. Significant thoracic spine pain was also reported during the last three months Medication: — Clinical Procedure: Surgical decompressive therapy, with abscess drainage, combined with appropriate antibiotic therapy for twelve weeks Specialty: Medicine, General and Internal Objective: Rare coexistence of disease or pathology Background: Pyogenic spondylitis comprises several clinical entities, including native vertebral osteomyelitis, septic discitis, pyogenic spondylodiscitis, and epidural abscess. The lumbar spine is most often infected, followed by the thoracic and cervical areas. It mainly develops (i) after spine surgery; (ii) from history of blunt trauma to the spinal column; (iii) from infections in adjacent structures (such as soft tissues); (iv) from iatrogenic inoculation after invasive procedures (such as lumbar puncture); and (v) from hematogenous bacterial spread to the vertebra (mainly through the venous route). Any delay in diagnosis and treatment can lead to significant spinal cord injury, permanent neurological damage, septicemia, and death. Case Report: We describe a 63-year-old man with no significant past medical history who presented with fever and an altered level of consciousness. Significant thoracic spine pain was also reported during the last 3 months. The final diagnosis was vertebral spondylodiscitis, contiguous spinal epidural abscess, and sepsis due to Bacteroides fragilis bacteremia. Clinical recovery was achieved after surgical decompressive therapy with abscess drainage combined with appropriate antibiotic therapy for 12 weeks. The primary focus of the infection was not clarified, despite all the investigations that were performed. Conclusions: Spondylodiscitis, spinal epidural abscess, and sepsis as complications of Bacteroides fragilis bacteremia are rare in a patient without any previously known predisposing conditions and without an obvious primary focus. Early diagnosis and proper treatment of anaerobic spondylodiscitis, especially if epidural abscess and sepsis are present, are of great importance to reduce mortality and avoid long-term complications.

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“…In a 10-year cohort study, Avenel et al recently found that, when VO was suspected on imaging, bacteriological investigation identified the microorganism in 209/300 (70%) of the cases [ 18 ]. The yield of percutaneous needle biopsy was 54.8% and the only predictor of percutaneous needle biopsy negativity, detected in a multivariate analysis was previous antibiotic intake [ 18 ]. There was no statistically significant difference in the frequencies of causative pathogens between the HAVO and CAVO cohort.…”

Section: Discussionmentioning

confidence: 99%

Is There a Difference in Clinical Features, Microbiological Epidemiology and Effective Empiric Antimicrobial Therapy Comparing Healthcare-Associated and Community-Acquired Vertebral Osteomyelitis?

et al. 2021

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Background: Empiric antibiotic therapy for suspected vertebral osteomyelitis (VO) should be initiated immediately in severely ill patients, and might be necessary for culture-negative VO. The current study aimed to identify differences between community-acquired (CA) and healthcare-associated (HA) VO in terms of clinical presentation, causative pathogens, and antibiotic susceptibility. Methods: Cases of adult patients with VO treated at a German university orthopaedic trauma center between 2000 and 2020 were retrospectively reviewed. Patient history was used to distinguish between CA and HA VO. Susceptibility of antibiotic regimens was assessed based on antibiograms of the isolated pathogens. Results: A total of 155 patients (with a male to female ratio of 1.3; and a mean age of 66.1 ± 12.4 years) with VO were identified. In 74 (47.7%) patients, infections were deemed healthcare-associated. The most frequently identified pathogens were Staphylococcus aureus (HAVO: 51.2%; CAVO: 46.8%), and Coagulase-negative Staphylococci (CoNS, HAVO: 31.7%; CAVO: 21.3%). Antibiograms of 45 patients (HAVO: n = 22; CAVO: n = 23) were evaluated. Significantly more methicillin-resistant isolates, mainly CoNS, were found in the HAVO cohort (27.3%). The highest rate of resistance was found for cefazolin (HAVO: 45.5%; CAVO: 26.1%). Significantly higher rates of resistances were seen in the HAVO cohort for mono-therapies with meropenem (36.4%), piperacillin–tazobactam (31.8%), ceftriaxone (27.3%), and co-amoxiclav (31.8%). The broadest antimicrobial coverage was achieved with either a combination of piperacillin–tazobactam + vancomycin (CAVO: 100.0%; HAVO: 90.9%) or meropenem + vancomycin (CAVO: 100.0%; HAVO: 95.5%). Conclusion: Healthcare association is common in VO. The susceptibility pattern of underlying pathogens differs from CAVO. When choosing an empiric antibiotic, combination therapy must be considered.

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Microbiological diagnosis of suspected vertebral osteomyelitis with a focus on the yield of percutaneous needle biopsy: a 10-year cohort study

Cited by 8 publications

References 26 publications

Large increase of vertebral osteomyelitis in France: a 2010–2019 cross-sectional study

Large increase of vertebral osteomyelitis in France: a 2010–2019 cross-sectional study

Bacteroides fragilis Bacteremia Complicated by Spondylodiscitis, Spinal Epidural Abscess, and Sepsis: A Case Report

Is There a Difference in Clinical Features, Microbiological Epidemiology and Effective Empiric Antimicrobial Therapy Comparing Healthcare-Associated and Community-Acquired Vertebral Osteomyelitis?

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