CORR Insights®: Treatment Guideline for Patients with Native Culture-negative Pyogenic Vertebral Osteomyelitis

Abstract Background It is difficult to select an appropriate empirical antibiotic treatment regimen for patients with culture-negative pyogenic vertebral osteomyelitis (PVO). Having knowledge of the distribution of microorganisms according to patient characteristics can help clinicians make informed choices regarding empirical antibiotics. The aim of this study was to determine the microbial distribution among individuals with PVO according to their demographic and clinical characteristics. Methods We reviewed the medical records of patients admitted to our hospital with culture-confirmed PVO between January 2005 and December 2017 and collected data on demographics, underlying diseases, and radiographic and microbiological results. Statistical analysis was performed to identify associations between specific bacteria and specific patient characteristics. Results A total of 586 patients were included in the study. The prevalence of Staphylococcus aureus infections was higher in young patients than in old patients, while gram-negative bacterial infections and Enterococcus were more prevalent in older patients. Gram-negative bacterial infections were more common in women than in men (32.1% vs 16.4%; P < .05), in patients with cirrhosis than in those without (32.7% vs 21.1%; P < .05), and in patients with a solid tumor than in those without (31.0% vs 20.7%; P < .05). Methicillin-resistant S. aureus infections were more prevalent in patients with chronic renal disease than in those without (34.4% vs 14.7%; P < .05). Conclusions The microbial etiology of PVO varies according to patient characteristics. Patient characteristics should thus be considered when choosing empirical antibiotics in patients with culture-negative PVO.

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Antimicrobial therapy and assessing therapeutic response in culture-negative pyogenic vertebral osteomyelitis: a retrospective comparative study with culture-positive pyogenic vertebral osteomyelitis

BMC Infectious Diseases ◽

10.1186/s12879-020-05669-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Dongwoo Yu ◽

Sang Woo Kim ◽

Ikchan Jeon

Keyword(s):

Back Pain ◽

Therapeutic Response ◽

Epidural Abscess ◽

Vertebral Osteomyelitis ◽

Bacterial Identification ◽

Oral Antibiotics ◽

Normal Range ◽

Pyogenic Vertebral Osteomyelitis ◽

Culture Positive ◽

Culture Negative

Abstract Background There are still controversies regarding the treatment and outcomes in culture-negative pyogenic vertebral osteomyelitis (PVO). The purpose of this study is to investigate the antimicrobial therapy, assessment of therapeutic response, and outcome of culture-negative PVO compared to culture-positive PVO. Methods A retrospective study was performed with non-surgical lumbar PVO patients. The patients were divided into two groups based on the causative bacterial identification (CN group with culture-negative PVO and CP group with culture-positive PVO). The clinical features, use of antibiotics, laboratory data, and outcomes were compared between the two groups. Results Seventy-three patients with 41 (56.2%) of the CN group and 32 (43.8%) of the CP group were enrolled. The CN group showed a shorter duration of parenteral antibiotics (45.88 ± 16.14 vs. 57.31 ± 24.39, p = 0.019) but a tendency of prolonged duration of total (parenteral + oral) antibiotics (101.17 ± 52.84 vs. 84.19 ± 50.29 days, p = 0.168). When parenteral antibiotics were discontinued or switched to oral antibiotics, the mean erythrocyte segmentation rate (ESR, normal range: < 25 mm/h), C-reactive protein (CRP, normal range: < 0.5 mg/dL) level, and visual analog scale (VAS) score of back pain were 42.86 ± 24.05 mm/h, 0.91 ± 1.18 mg/dL, and 4.05 ± 1.07, respectively, with no significant differences between the two groups. The recurrence rates of CN and CP groups were 7.3% (3/41) and 6.3% (2/32), respectively (p = 1.000). The presence of epidural abscess was the most significant factor for the identification of causative bacteria (p = 0.002), and there was no significant relationship between the use of empirical antibiotics before tissue culture and the causative bacterial identification (p = 0.194). Conclusions The CN group required a shorter duration of parenteral antibiotics than the CP group. Discontinuation of parenteral antibiotics or changing the administration route can be considered based on the values of ESR, CRP, and VAS score of back pain. The presence of epidural abscess was the most significant factor for the identification of causative bacteria.

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Successful use of tigecycline for treatment of culture-negative pyogenic vertebral osteomyelitis

Infectious Diseases ◽

10.3109/23744235.2015.1062132 ◽

2015 ◽

Vol 47 (11) ◽

pp. 783-788 ◽

Cited By ~ 6

Author(s):

Derya Seyman ◽

Hande Berk ◽

Nevgun Sepın-Ozen ◽

Fılız Kızılates ◽

Cezmı Cagrı Turk ◽

...

Keyword(s):

Vertebral Osteomyelitis ◽

Pyogenic Vertebral Osteomyelitis ◽

Culture Negative

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Antimicrobial therapy and assessing therapeutic response in culture-negative pyogenic vertebral osteomyelitis: a retrospective comparative study with culture-positive pyogenic vertebral osteomyelitis

10.21203/rs.3.rs-42510/v2 ◽

2020 ◽

Author(s):

Dongwoo Yu ◽

Sang Woo Kim ◽

Ikchan Jeon

Keyword(s):

Back Pain ◽

Therapeutic Response ◽

Epidural Abscess ◽

Vertebral Osteomyelitis ◽

Bacterial Identification ◽

Oral Antibiotics ◽

Normal Range ◽

Pyogenic Vertebral Osteomyelitis ◽

Culture Positive ◽

Culture Negative

Abstract Background: There are still controversies regarding the treatment and outcomes in culture-negative pyogenic vertebral osteomyelitis (PVO). The purpose of this study is to investigate the antimicrobial therapy, assessment of therapeutic response, and outcome of culture-negative PVO compared to culture-positive PVO.Methods: A retrospective study was performed with non-surgical lumbar PVO patients. The patients were divided into two groups based on the causative bacterial identification (CN group with culture-negative PVO and CP group with culture-positive PVO). The clinical features, use of antibiotics, laboratory data, and outcomes were compared between the two groups.Results: Seventy-three patients with 41 (56.2%) of the CN group and 32 (43.8%) of the CP group were enrolled. The CN group showed a shorter duration of parenteral antibiotics (45.88 ± 16.14 vs. 57.31 ± 24.39, p = 0.019) but a tendency of prolonged duration of total (parenteral + oral) antibiotics (101.17 ± 52.84 vs. 84.19 ± 50.29 days, p = 0.168). When parenteral antibiotics were discontinued or switched to oral antibiotics, the mean erythrocyte segmentation rate (ESR, normal range: < 25 mm/h), C-reactive protein (CRP, normal range: < 0.5 mg/dL) level, and visual analog scale (VAS) score of back pain were 42.86 ± 24.05 mm/h, 0.91 ± 1.18 mg/dL, and 4.05 ± 1.07, respectively, with no significant differences between the two groups. The recurrence rates of CN and CP groups were 7.3% (3/41) and 6.3% (2/32), respectively (p=1.000). The presence of epidural abscess was the most significant factor for the identification of causative bacteria (p = 0.002), and there was no significant relationship between the use of empirical antibiotics before tissue culture and the causative bacterial identification (p = 0.194).Conclusions: The CN group required a shorter duration of parenteral antibiotics than the CP group. Discontinuation of parenteral antibiotics or changing the administration route can be considered based on the values of ESR, CRP, and VAS score of back pain. The presence of epidural abscess was the most significant factor for the identification of causative bacteria.

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Treatment Strategy and Outcomes in Patients with Hematogenous Culture-Negative Pyogenic Vertebral Osteomyelitis

Asian Spine Journal ◽

10.31616/asj.2018.0093 ◽

2019 ◽

Vol 13 (1) ◽

pp. 61-67

Author(s):

Gouse Mohamad ◽

Rohit Amritanand ◽

Kenny Samuel David ◽

Venkatesh Krishnan ◽

Justin Arockiaraj

Keyword(s):

Treatment Strategy ◽

Vertebral Osteomyelitis ◽

Pyogenic Vertebral Osteomyelitis ◽

Culture Negative

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Antimicrobial therapy and assessing therapeutic response in culture-negative pyogenic vertebral osteomyelitis: a retrospective comparative study with culture-positive pyogenic vertebral osteomyelitis

10.21203/rs.3.rs-42510/v3 ◽

2020 ◽

Author(s):

Dongwoo Yu ◽

Sang Woo Kim ◽

Ikchan Jeon

Keyword(s):

Back Pain ◽

Therapeutic Response ◽

Epidural Abscess ◽

Vertebral Osteomyelitis ◽

Bacterial Identification ◽

Oral Antibiotics ◽

Normal Range ◽

Pyogenic Vertebral Osteomyelitis ◽

Culture Positive ◽

Culture Negative

Abstract Background: There are still controversies regarding the treatment and outcomes in culture-negative pyogenic vertebral osteomyelitis (PVO). The purpose of this study is to investigate the antimicrobial therapy, assessment of therapeutic response, and outcome of culture-negative PVO compared to culture-positive PVO.Methods: A retrospective study was performed with non-surgical lumbar PVO patients. The patients were divided into two groups based on the causative bacterial identification (CN group with culture-negative PVO and CP group with culture-positive PVO). The clinical features, use of antibiotics, laboratory data, and outcomes were compared between the two groups.Results: Seventy-three patients with 41 (56.2%) of the CN group and 32 (43.8%) of the CP group were enrolled. The CN group showed a shorter duration of parenteral antibiotics (45.88 ± 16.14 vs. 57.31 ± 24.39, p = 0.019) but a tendency of prolonged duration of total (parenteral + oral) antibiotics (101.17 ± 52.84 vs. 84.19 ± 50.29 days, p = 0.168). When parenteral antibiotics were discontinued or switched to oral antibiotics, the mean erythrocyte segmentation rate (ESR, normal range: < 25 mm/h), C-reactive protein (CRP, normal range: < 0.5 mg/dL) level, and visual analog scale (VAS) score of back pain were 42.86 ± 24.05 mm/h, 0.91 ± 1.18 mg/dL, and 4.05 ± 1.07, respectively, with no significant differences between the two groups. The recurrence rates of CN and CP groups were 7.3% (3/41) and 6.3% (2/32), respectively (p=1.000). The presence of epidural abscess was the most significant factor for the identification of causative bacteria (p = 0.002), and there was no significant relationship between the use of empirical antibiotics before tissue culture and the causative bacterial identification (p = 0.194).Conclusions: The CN group required a shorter duration of parenteral antibiotics than the CP group. Discontinuation of parenteral antibiotics or changing the administration route can be considered based on the values of ESR, CRP, and VAS score of back pain. The presence of epidural abscess was the most significant factor for the identification of causative bacteria.

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Antimicrobial therapy and assessing therapeutic response in culture-negative pyogenic vertebral osteomyelitis: a retrospective comparative study with culture-positive pyogenic vertebral osteomyelitis

10.21203/rs.3.rs-42510/v1 ◽

2020 ◽

Author(s):

Dongwoo Yu ◽

Sang Woo Kim ◽

Ikchan Jeon

Keyword(s):

Back Pain ◽

Antimicrobial Therapy ◽

Therapeutic Response ◽

Vertebral Osteomyelitis ◽

Oral Antibiotics ◽

Normal Range ◽

Vas Score ◽

Pyogenic Vertebral Osteomyelitis ◽

Culture Positive ◽

Culture Negative

Abstract Background There are still controversies over the treatment and outcomes in culture-negative pyogenic vertebral osteomyelitis (PVO). The purpose of this study is to investigate the antimicrobial therapy, assessment of therapeutic response, and outcome of culture-negative PVO compared to culture-positive PVO. Methods Retrospective study was performed with non-surgical lumbar PVO. The patients were divided into two groups based on the causative bacterial identification (CN group with culture-negative and CP group with culture-positive). The clinical features, use of antibiotics, laboratory data, and outcomes were compared between the two groups. Results Seventy-three patients with 41 (56.2%) of the CN group and 32 (43.8%) of the CP group were enrolled. Group CN showed a shorter duration of parenteral antibiotics (45.88 ± 16.14 vs. 57.31 ± 24.39, p = 0.019) although a tendency of prolonged duration of total (parenteral + oral) antibiotics (101.17 ± 52.84 vs. 84.19 ± 50.29 days, p = 0.168). When parenteral antibiotics were discontinued or switched to oral antibiotics, erythrocyte segmentation rate (ESR, normal range: < 20 mm/h), C-reactive protein (CRP, normal range: < 0.5 mg/dL), and visual analogue scale (VAS) score for back pain were 42.86 ± 24.05 mm/h, 0.91 ± 1.18 mg/dL, and 4.05 ± 1.07, respectively, with no significant differences between the two groups. The recurrence rates of CN and CP groups were 7.3% (3/41) and 6.3% (2/32), respectively (p = 1.000). Conclusions CN group required a shorter duration of parenteral antibiotics than CP group. Discontinuation of parenteral antibiotics or changing administration route can be considered based on the values of ESR, CRP, and VAS score for back pain.

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