The epidemiology of hematogenous vertebral osteomyelitis

A cohort study in a tertiary care hospital

Kavita P. Bhavan, Jonas Marschall, Margaret A. Olsen, Victoria J. Fraser, Neill M. Wright, David K. Warren

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Background: Vertebral osteomyelitis is a common manifestation of osteomyelitis in adults and associated with considerable morbidity. Limited data exist regarding hematogenous vertebral osteomyelitis. Our objective was to describe the epidemiology and management of hematogenous vertebral osteomyelitis.Methods: We performed a 2-year retrospective cohort study of adult patients with hematogenous vertebral osteomyelitis at a tertiary care hospital.Results: Seventy patients with hematogenous vertebral osteomyelitis were identified. The mean age was 59.7 years (±15.0) and 38 (54%) were male. Common comorbidities included diabetes (43%) and renal insufficiency (24%). Predisposing factors in the 30 days prior to admission included bacteremia (19%), skin/soft tissue infection (17%), and having an indwelling catheter (30%). Back pain was the most common symptom (87%). Seven (10%) patients presented with paraplegia. Among the 46 (66%) patients with a microbiological diagnosis, the most common organisms were methicillin-susceptible S. aureus [15 (33%) cases], and methicillin-resistant S. aureus [10 (22%)]. Among the 44 (63%) patients who had a diagnostic biopsy, open biopsy was more likely to result in pathogen recovery [14 (93%) of 15 with open biopsy vs. 14 (48%) of 29 with needle biopsy; p = 0.003]. Sixteen (23%) patients required surgical intervention for therapeutic purposes during admission.Conclusions: This is one of the largest series of hematogenous vertebral osteomyelitis. A microbiological diagnosis was made in only approximately two-thirds of cases. S. aureus was the most common causative organism, of which almost half the isolates were methicillin-resistant.

Original languageEnglish (US)
Article number158
JournalBMC Infectious Diseases
Volume10
DOIs
StatePublished - Jun 7 2010

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Osteomyelitis
Tertiary Healthcare
Tertiary Care Centers
Epidemiology
Cohort Studies
Methicillin Resistance
Biopsy
Soft Tissue Infections
Methicillin
Indwelling Catheters
Paraplegia
Needle Biopsy
Back Pain
Bacteremia
Causality
Renal Insufficiency
Comorbidity
Retrospective Studies
Morbidity
Skin

ASJC Scopus subject areas

  • Infectious Diseases

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The epidemiology of hematogenous vertebral osteomyelitis : A cohort study in a tertiary care hospital. / Bhavan, Kavita P.; Marschall, Jonas; Olsen, Margaret A.; Fraser, Victoria J.; Wright, Neill M.; Warren, David K.

In: BMC Infectious Diseases, Vol. 10, 158, 07.06.2010.

Research output: Contribution to journalArticle

Bhavan, Kavita P. ; Marschall, Jonas ; Olsen, Margaret A. ; Fraser, Victoria J. ; Wright, Neill M. ; Warren, David K. / The epidemiology of hematogenous vertebral osteomyelitis : A cohort study in a tertiary care hospital. In: BMC Infectious Diseases. 2010 ; Vol. 10.
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abstract = "Background: Vertebral osteomyelitis is a common manifestation of osteomyelitis in adults and associated with considerable morbidity. Limited data exist regarding hematogenous vertebral osteomyelitis. Our objective was to describe the epidemiology and management of hematogenous vertebral osteomyelitis.Methods: We performed a 2-year retrospective cohort study of adult patients with hematogenous vertebral osteomyelitis at a tertiary care hospital.Results: Seventy patients with hematogenous vertebral osteomyelitis were identified. The mean age was 59.7 years (±15.0) and 38 (54{\%}) were male. Common comorbidities included diabetes (43{\%}) and renal insufficiency (24{\%}). Predisposing factors in the 30 days prior to admission included bacteremia (19{\%}), skin/soft tissue infection (17{\%}), and having an indwelling catheter (30{\%}). Back pain was the most common symptom (87{\%}). Seven (10{\%}) patients presented with paraplegia. Among the 46 (66{\%}) patients with a microbiological diagnosis, the most common organisms were methicillin-susceptible S. aureus [15 (33{\%}) cases], and methicillin-resistant S. aureus [10 (22{\%})]. Among the 44 (63{\%}) patients who had a diagnostic biopsy, open biopsy was more likely to result in pathogen recovery [14 (93{\%}) of 15 with open biopsy vs. 14 (48{\%}) of 29 with needle biopsy; p = 0.003]. Sixteen (23{\%}) patients required surgical intervention for therapeutic purposes during admission.Conclusions: This is one of the largest series of hematogenous vertebral osteomyelitis. A microbiological diagnosis was made in only approximately two-thirds of cases. S. aureus was the most common causative organism, of which almost half the isolates were methicillin-resistant.",
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