European Spine Journal

, Volume 22, Issue 8, pp 1845–1853 | Cite as

The management gram-negative bacterial haematogenous vertebral osteomyelitis: a case series of diagnosis, treatment and therapeutic outcomes

  • Simon Matthew Graham
  • Adelle Fishlock
  • Peter Millner
  • Jonathan Sandoe
Original Article
First Online:
Received:
Revised:
Accepted:

Abstract

Purpose

The incidence of gram-negative bacterial haematogenous vertebral osteomyelitis (GNB HVO) is increasing. We performed a retrospective cohort study of patients with this type of infection in an effort to gain an improved understanding of the current clinical presentation, management and outcome.

Methods

Between May 2007 and May 2010, all patients, over the age of 18 years, suffering from GNB HVO were identified and their microbiological diagnoses were evaluated.

Results

This study identified seventy-nine patients with haematogenous vertebral osteomyelitis (HVO). Of these seventy-nine patients, 10 patients (12.66 %) had Gram-negative organisms isolated. These organisms included Escherichia coli (4), Pseudomonas aeruginosa (3), Klebsiella pneumonia (1), Haemophilus influenza (1) and Enterobacter cloacae (1). Eight patients were successfully treated with antibiotics and/or surgery. Of the eight patients whose HVO was cured, five had Ciprofloxacin as part of their definitive antibiotic regime.

Conclusion

The treatment of GNB HVO is often challenging because of unpredictable resistance patterns and limited published data on effective treatment regimens. Our study has highlighted the need for prompt microbiological sampling and initiation of early appropriate antibiotic regime. The most effective treatment for GNB HVO was with oral Ciprofloxacin over a period of 6–8 weeks.

Keywords

Discitis Gram-negative bacterial Haematogenous Vertebral osteomyelitis Infection 
This is a preview of subscription content, log in to check access.

Notes

Conflict of interest

The authors have no conflicts of interests.

References

  1. 1.
    Bhavan KP, Marschall J, Olsen MA, Fraser VJ, Wright NM, Warren DK (2010) The epidemiology of hematogenous vertebral osteomyelitis: a cohort study in a tertiary care hospital. BMC Infect Dis 10:158PubMedCrossRefGoogle Scholar
  2. 2.
    Jaramillo-de la Torre JJ, Bohinski RJ, Kuntz C 4th (2006) Vertebral osteomyelitis. Neurosurg Clin N Am 17(3) pp 339–51, viiGoogle Scholar
  3. 3.
    Carragee EJ (1997) Pyogenic vertebral osteomyelitis. J Bone Joint Surg Am 79(6):874–880PubMedGoogle Scholar
  4. 4.
    Priest DH, Peacock JE Jr (2005) Hematogenous vertebral osteomyelitis due to Staphylococcus aureus in the adult: clinical features and therapeutic outcomes. South Med J 98(9):854–862PubMedCrossRefGoogle Scholar
  5. 5.
    Peleg AY, Hooper DC (2010) Hospital-acquired infections due to gram-negative bacteria. N Engl J Med 362(19):1804–1813PubMedCrossRefGoogle Scholar
  6. 6.
    Garcia A Jr, Grantham SA (1960) Hematogenous pyogenic vertebral osteomyelitis. J Bone Joint Surg Am 42-A:429–436PubMedGoogle Scholar
  7. 7.
    Hadjipavlou AG, Mader JT, Necessary JT, Muffoletto AJ (2000) Hematogenous pyogenic spinal infections and their surgical management. Spine (Phila Pa 1976) 25(13):1668–1679CrossRefGoogle Scholar
  8. 8.
    McHenry MC, Easley KA, Locker GA (2002) Vertebral osteomyelitis: long-term outcome for 253 patients from 7 Cleveland-area hospitals. Clin Infect Dis 34(10):1342–1350PubMedCrossRefGoogle Scholar
  9. 9.
    Lazzarini L, Lipsky BA, Mader JT (2005) Antibiotic treatment of osteomyelitis: what have we learned from 30 years of clinical trials? Int J Infect Dis 9(3):127–138PubMedCrossRefGoogle Scholar
  10. 10.
    Osenbach RK, Hitchon PW, Menezes AH (1990) Diagnosis and management of pyogenic vertebral osteomyelitis in adults. Surg Neurol 33(4):266–275PubMedCrossRefGoogle Scholar
  11. 11.
    Chen WH, Jiang LS, Dai LY (2007) Surgical treatment of pyogenic vertebral osteomyelitis with spinal instrumentation. Eur Spine J 16(9):1307–1316PubMedCrossRefGoogle Scholar
  12. 12.
    Cottle L, Riordan T (2008) Infectious spondylodiscitis. J Infect 56(6):401–412PubMedCrossRefGoogle Scholar
  13. 13.
    Tsiodras S, Falagas ME (2006) Clinical assessment and medical treatment of spine infections. Clin Orthop Relat Res 444:38–50PubMedCrossRefGoogle Scholar
  14. 14.
    Krogsgaard MR, Wagn P, Bengtsson J (1998) Epidemiology of acute vertebral osteomyelitis in Denmark: 137 cases in Denmark 1978–1982, compared to cases reported to the National Patient Register 1991–1993. Acta Orthop Scand 69(5):513–517PubMedCrossRefGoogle Scholar
  15. 15.
    Bonfiglio M, Lange TA, Kim YM (1973) Pyogenic vertebral osteomyelitis. Disk space infections. Clin Orthop Relat Res 96:234–247PubMedCrossRefGoogle Scholar
  16. 16.
    Digby JM, Kersley JB (1979) Pyogenic non-tuberculous spinal infection: an analysis of thirty cases. J Bone Joint Surg Br 61(1):47–55PubMedGoogle Scholar
  17. 17.
    Jones NS, Anderson DJ (1987) Stiles PJ Osteomyelitis in a general hospital. A five-year study showing an increase in subacute osteomyelitis. J Bone Joint Surg Br 69(5):779–783PubMedGoogle Scholar
  18. 18.
    Beronius M, Bergman B, Andersson R (2001) Vertebral osteomyelitis in Goteborg, Sweden: a retrospective study of patients during 1990–95. Scand J Infect Dis 33(7):527–532PubMedCrossRefGoogle Scholar
  19. 19.
    Wisneski RJ (1991) Infectious disease of the spine. Diagnostic and treatment considerations. Orthop Clin North Am 22(3):491–501PubMedGoogle Scholar
  20. 20.
    Schurman DJ, Wheeler R (1978) Gram negative bone and joint infection: sixty patients treated with amikacin. Clin Orthop Relat Res 134:268–274PubMedGoogle Scholar
  21. 21.
    Norden CW, Shinners E (1985) Ciprofloxacin as therapy for experimental osteomyelitis caused by Pseudomonas aeruginosa. J Infect Dis 151(2):291–294PubMedCrossRefGoogle Scholar
  22. 22.
    Lew DP, Waldvogel FA (1995) Quinolones and osteomyelitis: state-of-the-art. Drugs 49(Suppl 2):100–111PubMedCrossRefGoogle Scholar
  23. 23.
    Gentry LO, Rodriguez GG (1990) Oral Ciprofloxacin compared with parenteral antibiotics in the treatment of osteomyelitis. Antimicrob Agents Chemother 34(1):40–43PubMedCrossRefGoogle Scholar
  24. 24.
    Carragee EJ (1997) Instrumentation of the infected and unstable spine: a review of 17 cases from the thoracic and lumbar spine with pyogenic infections. J Spinal Disord 10(4):317–324PubMedCrossRefGoogle Scholar
  25. 25.
    Dietze DD, Fessler RG Jr, Jacob RP (1997) Primary reconstruction for spinal infections. J Neurosurg 86(6):981–989PubMedCrossRefGoogle Scholar
  26. 26.
    Dimar JR, Carreon LY, Glassman SD, Campbell MJ, Hartman MJ, Johnson JR (2004) Treatment of pyogenic vertebral osteomyelitis with anterior debridement and fusion followed by delayed posterior spinal fusion. Spine (Phila Pa 1976) 29(3):326–332 (discussion 332)CrossRefGoogle Scholar
  27. 27.
    Emery SE, Chan DP, Woodward HR (1989) Treatment of hematogenous pyogenic vertebral osteomyelitis with anterior debridement and primary bone grafting. Spine (Phila Pa 1976) 14(3):284–289Google Scholar
  28. 28.
    Cunha BA, Gossling HR, Pasternak HS, Nightingale CH, Quintiliani R (1977) The penetration characteristics of cefazolin, cephalothin and cephradine into bone in patients undergoing total hip replacement. J Bone Joint Surg Am 59(7):856–860PubMedGoogle Scholar
  29. 29.
    Summersgill JT, Schupp LG, Raff MJ (1982) Comparative penetration of metronidazole, clindamycin, chloramphenicol, cefoxitin, ticaricillin and moxalactam into bone. Antimicrob Agents Chemother 21(4):601–603PubMedCrossRefGoogle Scholar
  30. 30.
    Landersdorfer CB, Bulitta JB, Kinzig M, Holzgrabe U, Sorgel F (2009) Penetration of antibacterials into bone: pharmacokinetic, pharmacodynamic and bioanalytical considerations. Clin Pharmacokinet 48(2):89–124PubMedCrossRefGoogle Scholar
  31. 31.
    Grados F, Lescure FX, Senneville E, Flipo RM, Schmit JL, Fardellone P (2007) Suggestions for managing pyogenic (non-tuberculous) discitis in adults. Jt Bone Spine 74(2):133–139CrossRefGoogle Scholar
  32. 32.
    Norden CW, Shaffer M (1983) Treatment of experimental chronic osteomyelitis due to Staphylococcus aureus with vancomycin and rifampicin. J Infect Dis 147(2):352–357PubMedCrossRefGoogle Scholar
  33. 33.
    Verklin RM, Mandell GL (1976) Alteration of effectiveness of antibiotics by anaerobiosis. J Lab Clin Med 89(1):65–71Google Scholar
  34. 34.
    Holm SH (1990) Nutrition of the intervertebral disc. In: Weinstein JN, Wiesel SW (eds) The lumbar spine. W. B. Saunders Company, Philadelphia, pp 244–260Google Scholar
  35. 35.
    Stein GE (1996) Pharmacokinetics and pharmacodynamics of newer fluoroquinolones. Clin Infect Dis 23(Suppl l):S9–S24Google Scholar
  36. 36.
    Fraimow HS (2009) Systemic antimicrobial therapy in osteomyelitis. Semin Plast Surg 23(2):90–99PubMedCrossRefGoogle Scholar
  37. 37.
    McKinnon PS, Davis SL (2004) Pharmacokinetic and pharmacodynamic issues in the treatment of bacterial infectious diseases. Eur J Clin Microbiol Infect Dis 23(4):271–288PubMedCrossRefGoogle Scholar
  38. 38.
    Rissing JP (1997) Antimicrobial therapy for chronic osteomyelitis in adults: role of the quinolones. Clin Infect Dis 25(6):1327–1333PubMedCrossRefGoogle Scholar
  39. 39.
    Aldridge KE, Ashcraft D (1997) Comparison of the in vitro activities of BAY 12–8039, a new quinolone, and other antimicrobials against clinically important anaerobes. Antimicrob Agents Chemother 41(7):709–711PubMedGoogle Scholar
  40. 40.
    Brueggemann AB, Kugler KC, Doern GV (1997) In vitro activity of BAY 12–8039, a novel 8-methoxyquinolone, compared to activities of six fluoroquinolones against Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Antimicrob Agents Chemother 41(7):1594–1597PubMedGoogle Scholar
  41. 41.
    Dalhoff A, Petersen U, Endermann R (1996) In vitro activity of BAY 12–8039, a new 8-methoxyquinolone. Chemotherapy 42(6):410–425PubMedCrossRefGoogle Scholar
  42. 42.
    Goldstein EJC, Citron DM, Hudspeth M, Gerardo SH, Merriam CV (1997) In vitro activity of Bay 12–8039, a new 8-methoxyquinolone, compared to the activities of 11 other oral antimicrobial agents against 390 aerobic and anaerobic bacteria isolated from human and animal bite wound skin and soft tissue infections in humans. Antimicrob Agents Chemother 41(7):1552–1557PubMedGoogle Scholar
  43. 43.
    Visalli MA, Jacobs MR, Appelbaum PC (1996) Activity of CP 99,219 (trovafloxacin) compared with Ciprofloxacin, sparfloxacin, clinafloxacin, lomefloxacin and Cefuroxime against ten penicillin-susceptible and penicillin-resistant pneumococci by time-kill methodology. J Antimicrob Chemother 37(1):77–84PubMedCrossRefGoogle Scholar
  44. 44.
    Ji B, Lounis N, Maslo C, Truffot-Pernot C, Bonnafous P, Grosset J (1998) In vitro and in vivo activities of moxifloxacin and clinafloxacin against mycobacterium tuberculosis. Antimicrob Agents Chemother 42(8):2066–2069PubMedGoogle Scholar
  45. 45.
    Malincarne L, Ghebregzabher M, Moretti MV, Egidi AM, Canovari B, Tavolieri G, Francisci D, Cerulli G, Baldelli F (2006) Penetration of moxifloxacin into bone in patients undergoing total knee arthroplasty. J Antimicrob Chemother 57(5):950–954PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Simon Matthew Graham
    • 1
  • Adelle Fishlock
    • 1
  • Peter Millner
    • 1
  • Jonathan Sandoe
    • 1
  1. 1.Academic Departments of Trauma and Orthopaedics and the MicrobiologyTeaching Hospitals NHS TrustLeedsUK

Personalised recommendations