Native vertebral osteomyelitis in aged patients: distinctive features. An observational cohort study
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To describe the demographic, clinical, and microbiological profile of native vertebral osteomyelitis (NVO) in aged patients as compared to that of younger patients, to identify differences that could motivate changes in clinical management.
Retrospective, observational cohort study (1990–2015) including all adult patients with microbiologically confirmed NVO divided into 2 groups: aged (≥ 65 years) vs younger (18–64 years).
247 patients included, 138 aged and 109 younger. Relative to younger patients, the aged had higher rates of healthcare-related infection (40.6 vs 25.7%, p = 0.014), previous known heart valve disease (29.7 vs 9.2%, p < 0.001), and concomitant infective endocarditis (38.4 vs 20.2%, p = 0.002). The groups showed similar rates of symptomatic spinal cord compression (14.5 vs 11.9%, p = 0.556) and paraspinal abscesses (62.3 vs 68.8%, p = 0.288) at presentation. There was a trend to lower spine surgery rates in the aged (11.6 vs 17.4%, p = 0.192). On univariate analysis, Staphylococcus aureus infection was associated with higher in-hospital mortality in aged (29%, OR 4.3, 95% CI 1.61–11.45). In-hospital mortality was higher among the aged (14.5 vs 6.4%, p = 0.044) as well as relapse rate due to treatment failure (3.4 vs 1%, p = 0.377).
The findings underscore the importance of preventing healthcare-related infection and maintaining high clinical suspicion of infective endocarditis in aged NVO patients to implement proper management. S. aureus infection had a poorer prognosis in this population. As compared to younger patients, spinal surgery rates were slightly lower and overall prognosis poorer in the aged, despite similar rates of symptomatic spinal cord compression and abscesses at presentation.
KeywordsNative vertebral osteomyelitis Aged Bone infections Healthcare-related infection Infective endocarditis
All authors had access to the data and a role in writing the manuscript. We thank Celine Cavallo for language support.
Supported by Plan Nacional de I+D+I 2013–2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003)—co-financed by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014–2020.
Compliance with ethical standards
Conflict of interest
The authors declare that there is no conflict of interest.
- 4.Durante-Mangoni E, Bradley S, Selton-Suty C, Tripodi M-F, Barsic B, Bouza E, et al. Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study. Arch Intern Med. 2008;168:2095–103. https://doi.org/10.1001/archinte.168.19.2095.CrossRefPubMedGoogle Scholar
- 7.Pigrau C, Rodríguez-Pardo D, Fernández-Hidalgo N, Moretó L, Pellise F, Larrosa M, et al. Health care associated hematogenous pyogenic vertebral osteomyelitis: a severe and potentially preventable infectious disease. Medicine (Baltimore). 2015;94:e365. https://doi.org/10.1097/MD.0000000000000365.CrossRefGoogle Scholar
- 10.Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49:1–45. https://doi.org/10.1086/599376.CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Renz N, Haupenthal J, Schuetz MA, Trampuz A. Hematogenous vertebral osteomyelitis associated with intravascular device-associated infections—a retrospective cohort study. Diagn Microbiol Infect Dis. 2017;88:75–81. https://doi.org/10.1016/j.diagmicrobio.2017.01.020.CrossRefPubMedGoogle Scholar
- 18.Berbari EF, Kanj SS, Kowalski TJ, Darouiche RO, Widmer AF, Schmitt SK, et al. 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis. 2015;61:e26–46. https://doi.org/10.1093/cid/civ482.CrossRefPubMedGoogle Scholar
- 24.Chang W-S, Ho M-W, Lin P-C, Ho C-M, Chou C-H, Lu M-C, et al. Clinical characteristics, treatments, and outcomes of hematogenous pyogenic vertebral osteomyelitis, 12-year experience from a tertiary hospital in central Taiwan. J Microbiol Immunol Infect. 2017. https://doi.org/10.1016/j.jmii.2017.08.002.Google Scholar