Pyogenic vertebral osteomyelitis: identification of microorganism and laboratory markers used to predict clinical outcome

Abstract

The aim of this study is to determine the predictive values of laboratory indicators of pyogenic vertebral osteomyelitis (PVO) and a potential cure if the microorganism cannot be identified. Forty-five consecutive patients with PVO were enrolled. Antibiotic therapy with or without surgery was performed according to microorganism. In the negative-culture (NC) group, cefazolin was administered in cases of hematogenous PVO, and vancomycin was administered in cases of postoperative or procedure-related PVO. The clinical, laboratory, and radiological findings were followed up with regard to an appropriate response to antimicrobial therapy. Nine patients were treated with antibiotics alone. We were able to identify the microorganism in 34 cases (75.6%). Ten cases in NC group were cured without recurrence, but one was not. Identification of the microorganisms did not have any significant influence on the treatment outcome, duration of antibiotic administration or normalization of laboratory profiles. For erythrocyte sedimentation rate (ESR) values over 55 mm/h and C-reactive protein (CRP) values of 2.75 mg/dL at fourth week after antibiotic administration by means of ROC curve analysis, we expect significantly high rates of treatment failure by Pearson chi(2) test (chi(2) = 4.344, Odds ratio = 5.15, p = 0.037, 95% CI 1.004-26.597). Even in patients with negative culture findings, it is expected that a good outcome will be achieved by the administration of cefazolin or vancomycin for about 6 weeks. It is concluded that antibiotics selected according to the etiological setting can be initiated without the need to start empirical antibiotics. In every instance at fourth week after the initiation of antibiotic therapy, the values of CRP and ESR can provide meaningful information regarding whether clinicians need to reevaluate the effectiveness of antibiotics by performing follow-up imaging studies and monitoring the patient's clinical manifestations.

Vertebral Osteomyelitis in Adult Patients – Characteristics and Outcome

“…Generally, most patients were older men, experienced pain and had fever, and one-third of patients had neurological complications, confirming previous findings 14,16,17 . Spinal infection was most frequently located in the lumbar spine and usually affected two neighboring vertebrae and intervening disc, which is similar to other previously conducted studies 2,5 .…”

Spondylodiscitis in patients under haemodyalisis

“…When the bacteria is not identified we use cloxacillin alone or associated with other antibiotics. Recent studies have found no significant differences in relation to treatment outcome between patients with or without a microbiological diagnosis [25], although it is a worldwide rule that, whenever possible, therapy must be instituted with intravenous antibiotics based on cultures and bacterial sensitivity.…”

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the “surgical and research” articles in the European Spine Journal, 2010

“…The paper by Yoon [56] reassuringly lets us learn that although one should strive to find the infecting organism, which they only identify it in 75% of cases, patients can be treated successfully with what they describe as ''antibiotics selected according to etiological setting'', which in their case were cefazolin or vancomycin, and the values of CRP and ESR were reliable guides of successful recovery.…”