Optimal Duration of Antibiotic Therapy in Patients With Hematogenous Vertebral Osteomyelitis at Low Risk and High Risk of Recurrence

Park, Ki Ho; Cho, Oh Hyun; Lee, Jun Young; Park, Ji Seon; Ryu, Kyung Nam; Park, Seong Yeon; Lee, Yu‐Mi; Chong, Yong Pil; Kim, Sung-Han; Lee, Sang‐Oh; Choi, Sang‐Ho; Bae, In-Gyu; Kim, Yang Soo; Woo, Jun Hee; Lee, Mi Suk

doi:10.1093/cid/ciw098

Cited by 128 publications

(102 citation statements)

References 35 publications

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“…This is of critical importance in patients who require valve surgery because a persistent source of infection may serve as a source from which a recently placed prosthetic valve or annuloplasty ring becomes infected 101,102 . Some metastatic foci, such as vertebral osteomyelitis, may require additional antibiotic therapy beyond what is typically indicated for IE 179 . There is currently insufficient evidence to recommend specific imaging strategies to look for metastatic foci in all patients with IE.…”

Section: Managementmentioning

confidence: 99%

Infective endocarditis

Holland

Baddour

Bayer³

et al. 2016

Nat Rev Dis Primers

342

278

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Infective endocarditis (IE) is a rare, life-threatening disease that has long-lasting effects even among patients who survive and are cured. IE disproportionately affects those with underlying structural heart disease and is increasingly associated with healthcare contact, particularly in patients who have intravascular prosthetic material. In the setting of bacteraemia with a pathogenic organism, an infected vegetation may form as the end result of complex interactions between invading microorganisms and the host immune system. Once established, IE can involve almost any organ system in the body. The diagnosis of IE may be difficult to establish and a strategy that combines clinical, microbiological and echocardiography results has been codified in the modified Duke criteria. In cases of blood culture-negative IE, the diagnosis may be especially challenging and novel microbiological and imaging techniques have been developed to establish its presence. Once diagnosed, IE is best managed by a multidisciplinary team with expertise in infectious diseases, cardiology and cardiac surgery. Antibiotic prophylaxis for the prevention of IE remains controversial. Efforts to develop a vaccine targeting common bacterial causes of IE are ongoing, but have not yet yielded a commercially available product.

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Section: Managementmentioning

confidence: 99%

Infective endocarditis

Holland

Baddour

Bayer³

et al. 2016

Nat Rev Dis Primers

342

278

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“…However, there was evidence that advanced age (≥ 75 years) and S. aureus are risk factors for the failure of antibiotic therapy. Another retrospective study (n = 314) identified risk factors for recurrence, classified patients into high-risk and low-risk groups, and correlated treatment success with treatment duration (39). The mean time to relapse was given as 5 weeks (1.5 weeks−30 months), and infections with methicillin-resistant S. aureus (MRSA), undrained paravertebral and psoas abscesses, as well as severe kidney failure were identified as independent risk factors.…”

Section: Signs Of Paravertebral/epidural Inflammationmentioning

confidence: 99%

Spondylodiscitis: Diagnosis and Treatment Options

Herren

Jung

Pishnamaz

et al. 2017

Deutsches Ärzteblatt International

146

161

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“…The recurrence rates reported in the previous literatures have varied greatly. McHenry et al [15] reported a recurrence rate of 14% in 253 patients; Park et al [16] of 9.9% in 314 patients; and Kim et al [14] of 6.6% in 151 patients. Unfortunately, data to guide the optimal duration of antibiotic therapy related to the recurrence of PVO are insu cient [7,17,18].…”

Section: Discussionmentioning

confidence: 98%

Antimicrobial therapy and assessing therapeutic response in culture-negative pyogenic vertebral osteomyelitis: a retrospective comparative study with culture-positive pyogenic vertebral osteomyelitis

Kim

Jeon³

2020

Preprint

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Background There are still controversies over the treatment and outcomes in culture-negative pyogenic vertebral osteomyelitis (PVO). The purpose of this study is to investigate the antimicrobial therapy, assessment of therapeutic response, and outcome of culture-negative PVO compared to culture-positive PVO. Methods Retrospective study was performed with non-surgical lumbar PVO. The patients were divided into two groups based on the causative bacterial identification (CN group with culture-negative and CP group with culture-positive). The clinical features, use of antibiotics, laboratory data, and outcomes were compared between the two groups. Results Seventy-three patients with 41 (56.2%) of the CN group and 32 (43.8%) of the CP group were enrolled. Group CN showed a shorter duration of parenteral antibiotics (45.88 ± 16.14 vs. 57.31 ± 24.39, p = 0.019) although a tendency of prolonged duration of total (parenteral + oral) antibiotics (101.17 ± 52.84 vs. 84.19 ± 50.29 days, p = 0.168). When parenteral antibiotics were discontinued or switched to oral antibiotics, erythrocyte segmentation rate (ESR, normal range: < 20 mm/h), C-reactive protein (CRP, normal range: < 0.5 mg/dL), and visual analogue scale (VAS) score for back pain were 42.86 ± 24.05 mm/h, 0.91 ± 1.18 mg/dL, and 4.05 ± 1.07, respectively, with no significant differences between the two groups. The recurrence rates of CN and CP groups were 7.3% (3/41) and 6.3% (2/32), respectively (p = 1.000). Conclusions CN group required a shorter duration of parenteral antibiotics than CP group. Discontinuation of parenteral antibiotics or changing administration route can be considered based on the values of ESR, CRP, and VAS score for back pain.

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Optimal Duration of Antibiotic Therapy in Patients With Hematogenous Vertebral Osteomyelitis at Low Risk and High Risk of Recurrence

Abstract: Antibiotic therapy of prolonged duration (≥8 weeks) should be given to patients with HVO at high risk of recurrence. For low-risk patients, a shorter duration (6-8 weeks) of pathogen-directed antibiotic therapy may be sufficient.

Cited by 128 publications

References 35 publications

Infective endocarditis

Infective endocarditis

Spondylodiscitis: Diagnosis and Treatment Options

Antimicrobial therapy and assessing therapeutic response in culture-negative pyogenic vertebral osteomyelitis: a retrospective comparative study with culture-positive pyogenic vertebral osteomyelitis

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