Vertebral Osteomyelitis: A Comparison of Associated Outcomes in Early Versus Delayed Surgical Treatment

Segreto, Frank A.; Beyer, George A.; Grieco, Preston W.; Horn, Samantha R.; Bortz, Cole; Jalai, Cyrus M.; Passias, Peter G.; Paulino, Carl B.; Diebo, Bassel G.

doi:10.14444/5088

Cited by 28 publications

(29 citation statements)

References 38 publications

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“…Third, the timing of surgical intervention for PVO remains controversial [3]. Segreto et al found an immediate operation defined by within 24 hours of admission may reduce complications and mortality among patients with PVO in a claim database [28]. Other studies based on single-center experience showed no significant benefit from early abscess drainage [29, 30], which was consistent to our findings.…”

Section: Discussionsupporting

confidence: 87%

First-4-week erythrocyte sedimentation rate variability predicts erythrocyte sedimentation rate trajectories and clinical course among patients with pyogenic vertebral osteomyelitis

et al. 2019

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BackgroundThe trajectory pattern of erythrocyte sedimentation rate (ESR) in patients with pyogenic vertebral osteomyelitis (PVO) and its clinical significance is unclear. We further evaluated whether the first-4-week ESR variability can predict the trajectory pattern, treatment duration and recurrence of PVO.MethodsThe longitudinal ESR patterns of adults with PVO within the first 6 months were characterized through group-based trajectory modeling (GBTM). The ESR variability within the first 4 weeks was defined using the absolute difference (AD), coefficient of variation, percent change, and slope change. The first-4-week ESR variabilities were analyzed using ordinal logistic regression to predict the 6-month ESR trajectory and using logistic regression to predict treatment duration and recurrence likelihood. The discrimination and calibration of the prediction models were evaluated.ResultsThree ESR trajectory patterns were identified though GBTM among patients with PVO: Group 1, initial moderate high ESR with fast response; Group 2, initial high ESR with fast response; Group 3, initial high ESR with slow response. Group 3 patients (initial high ESR with slow response) were older, received longer antibiotic treatment, and had more comorbidities and higher recurrence rates than patients in the other two groups. The initial ESR value and ESR − AD could predict the 6-month ESR trajectory. By incorporating the first-4-week ESR variabilities and the clinical features of patients, our models exhibited moderate discrimination performance to predict prolonged treatment (≥12 weeks; C statistic, 0.75; 95% confidence interval [CI], 0.70 to 0.81) and recurrence (C statistic, 0.69; 95% CI, 0.61 to 0.78).ConclusionsThe initial ESR value and first-4-week ESR variability are useful markers to predict the treatment duration and recurrence of PVO. Future studies should validate our findings in other populations.

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Section: Discussionsupporting

confidence: 87%

First-4-week erythrocyte sedimentation rate variability predicts erythrocyte sedimentation rate trajectories and clinical course among patients with pyogenic vertebral osteomyelitis

et al. 2019

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“…2 Delaying a necessary surgical intervention is associated with an increased mortality and morbidity. 24…”

Section: Discussionmentioning

confidence: 99%

Vertebral Osteomyelitis: A Mortality Analysis Comparing Surgical and Conservative Management

Zadran

Pedersen

Eiskjær

2019

Global Spine Journal

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Study Design: Retrospective cohort study. Objectives: To compare the mortality between patients treated for vertebral osteomyelitis (VO) with either surgical or conservative management and to construct a predictive model for mortality after VO. Methods: All patients with a diagnosis of VO in Region North Denmark from 2004 to 2014 were followed for at least 2 years or until death. They were all treated according to a standardized guideline for the choice of treatment modality. Nineteen dichotomized variables with possible influence on the mortality were registered for all patients in the study. LASSO (least absolute shrinkage and selection operator) penalized Cox regression analysis was used to build a predictive model for 2-year survival after VO. Results: A total of 125 patients were eligible for inclusion, mean age 67 years, 36 women. 75 were treated surgically. Twenty-one patients were dead 2 years after the diagnosis. Kaplan-Meier estimate of 2-year survival was 0.82 [0.75, 0.88]. Any difference in mortality between surgically and conservatively treated patients was nonsignificant at 1 and 2 years (univariate Cox regression analysis). Significant factors included in the predictive model after LASSO penalized Cox regression analysis was Charlson Comorbidity Index (CCI), cardiovascular disease, C-reactive protein (CRP) normalization, thoracic infection, and Karnofsky score. The area under the curve (AUC) for the predictive model ranged from 0.74 to 0.77. Conclusion: Patients undergoing surgical management for vertebral osteomyelitis according to standardized and agreed-upon guidelines had no higher mortality than those allocated to conservative treatment. The predictive model included 5 variables associated with an increased mortality: CCI, CRP normalization, cardiovascular disease, thoracic infection, and Karnofsky score.

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“…In the study by Bernard et al [70]a high proportion (44%) of patients were treated with predominantly oral antibiotics; with 52% of patients overall receiving intravenous treatment for less than 14 days in a non-standardised fashion. The results from the OVIVA study [73] , a recently A study by Segreto, et al evaluated the outcomes of early (less than 24 hours) versus delayed surgical treatment of VO using a large nationwide inpatient database [3]. This study found that VO patients who underwent surgery after 24 hours of admission had higher likelihood of morbidity and mortality.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Prior studies report conflicting findings. While some authors have found an advantage to earlier surgical intervention, others have not been able to show benefit[3]. All these studies are limited.…”

mentioning

confidence: 98%

Hot topics on vertebral osteomyelitis from the International Society of Antimicrobial Chemotherapy

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Esposito

Ascione³

et al. 2019

International Journal of Antimicrobial Agents

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Vertebral osteomyelitis (VO), also known as spondylodiscitis, describes infections of the vertebrae and intervertebral discs. Discitis describes infection limited to the intervertebral discs; in clinical practice both discitis and VO can be regarded as different stages of a single entity. VO can be caused by bacteria, fungi and parasites The incidence of VO is increasing globally representing 3-5% of all osteomyelitis with an estimated incidence ranging from 4 to 24 per million per year. Increasing incidence has been attributed to a combination of improved diagnostics, increased healthcare associated infections, haemodialysis, indwelling catheters, intravenous drug use, spinal instrumentation, immunocompromised hosts and an ageing population [1]. If left untreated, VO can lead to irreversible spinal cord injury, deformity, neurologic deficits, septicaemia, and mortality (mortality rates ranges 4%-29%). VO is typically treated with antibiotics, but up to 40% to 50% of VO patients may eventually require surgical intervention [1-3] Despite advances in diagnostic modalities, medical and surgical care, there are still many controversial areas with regards to both diagnostic and therapeutic strategies in VO. In this review a number of 'hot topics' on VO were selected and reviewed by members of the Skin, Soft Tissue and Bone Infections Working Group of the International Society of Antimicrobial Chemotherapy (ISAC). This group includes international scientists, microbiology and infectious diseases clinicians and academics, whose aim is to advance the education and the science of infection management. This paper is an in-depth review of the current literature, providing a summary of the various aspects of VO and expert opinions and insights from the authors' own experience, highlighting areas for future study and research.

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Vertebral Osteomyelitis: A Comparison of Associated Outcomes in Early Versus Delayed Surgical Treatment

Cited by 28 publications

References 38 publications

First-4-week erythrocyte sedimentation rate variability predicts erythrocyte sedimentation rate trajectories and clinical course among patients with pyogenic vertebral osteomyelitis

First-4-week erythrocyte sedimentation rate variability predicts erythrocyte sedimentation rate trajectories and clinical course among patients with pyogenic vertebral osteomyelitis

Vertebral Osteomyelitis: A Mortality Analysis Comparing Surgical and Conservative Management

Hot topics on vertebral osteomyelitis from the International Society of Antimicrobial Chemotherapy

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