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Volume 51, Number 2, April 2018

Clinical characteristics, treatments, and outcomes of hematogenous pyogenic vertebral osteomyelitis, 12-year experience from a tertiary hospital in central Taiwan 


Wei-Shuo Chang, Mao-Wang Ho, Po-Chang Lin, Cheng-Mao Ho, Chia-Hui Chou, Min-Chi Lu, Yen-Jen Chen, Hsien-Te Chen, Jen-Hsien Wang, Chih-Yu Chi


 

Corresponding author:

Affiliations
Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
Correspondence
Corresponding author. Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, #2 Yu-Der Road, Taichung 40447, Taiwan. Fax: +886 4 2206 4008. 



 

Background and purpose: 

In Taiwan, studies about hematogenous pyogenic vertebral osteomyelitis (HPVO) are limited. We conducted a retrospective study to evaluate the clinical presentations, treatment, and outcomes of patients with the diagnosis of HPVO. 



 

Methods:

This 12.5-year retrospective study included patients with a diagnosis of HPVO. Medical records of all HPVO patients were thoroughly reviewed and their clinical data were analyzed by the SPSS software. 



 

Results:

414 HPVO cases were included and the mean age was 61.6 ± 13.4 years. The mean duration of symptoms was 29 ± 35.3 days and pain over the affected site was reported by most patients (86.0%). Gram-positive bacteria, especially Staphylococcus aureus (162/399 = 40.6%), were the main HPVO pathogens. Escherichia coli (42/399 = 10.5%) was the most common gram-negative isolate. Surgery was performed in 68.8% of cases and the mean duration of total antibiotic treatment was 104.7 ± 77.7 days. All-cause mortality and recurrence rates were 6.3% and 18.8%, respectively. In multivariate analysis, polymicrobial infection (OR: 4.154, 95% CI: 1.039–16.604, p = 0.044), multiple vertebral body involvement (OR: 2.202, 95% CI: 1.088–4.457, p = 0.028), abscess formation treated with antibiotics alone (OR: 2.912, 95% CI: 1.064–7.966, p = 0.037), and the duration of antimicrobial treatment less than 4 weeks (OR: 3.737, 95% CI: 1.195–11.683, p = 0.023) were associated with HPVO recurrence. 



 

Conclusion:

In Taiwan, HPVO mainly affected the elderly and S. aureus remained the most common HPVO pathogen. In patients with risk factors associated with HPVO recurrence, a longer duration (≥6 weeks) of antimicrobial therapy is suggested. 



 

Key words:

Osteomyelitis, Spondylitis, Pyogenic, Hematogenous, Spine