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

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.

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

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.

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

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.

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

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.

scholarly journals Clinical and Radiological Analysis of Pyogenic Vertebral Osteomyelitis Immediately after Successful Antimicrobial Therapy: Considerations for Assessing Therapeutic Response

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 861
Author(s):  
Ikchan Jeon ◽  
Eunjung Kong ◽  
Dongwoo Yu ◽  
Cheol Pyo Hong
Keyword(s):  
Back Pain ◽  
Clinical Features ◽  
Vertebral Body ◽  
Antimicrobial Therapy ◽  
Fdg Pet ◽  
Therapeutic Response ◽  
Vertebral Osteomyelitis ◽  
Paravertebral Muscle ◽  
Radiological Features ◽  
Pyogenic Vertebral Osteomyelitis

Purpose: The clinical and radiological abnormal findings continue even after successful treatment in pyogenic vertebral osteomyelitis (PVO). We analyzed the clinical and radiological features of cured PVO based on 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (FDG-PET/MRI) and compared the radiological differences between FDG-PET and MRI for assessing therapeutic response in PVO. Methods: This study included 43 patients (28 men and 15 women) with lumbar PVO who had no recurrence after successful antimicrobial therapy. They were divided into two groups based on the location of maximum standardized FDG uptake value (SUVmax) of PVO lesion on FDG-PET/MRI when parenteral antibiotics were discontinued (31 in group A: Intervertebral structure; 12 in group B: Vertebral body and paravertebral muscle). The differences of clinical symptoms, hematological inflammatory indices, and radiological features were retrospectively analyzed. Results: The patients were treated with 42.28 ± 14.58 (21–89) days of parenteral antibiotics. There were significant differences in C-reactive protein (0.97 ± 1.10 vs. 0.51 ± 0.31 mg/dL, p = 0.041; normal range of CRP < 0.5), back pain (4.29 ± 1.13 vs. 3.50 ± 1.00, p = 0.040; visual analog scale), and SUVmax (4.34 ± 1.24 vs. 5.89 ± 1.57, p < 0.001) between the two groups. In the distribution pattern of PVO lesions, FDG-PET overall showed recovery pattern earlier than MRI did (p < 0.001). Conclusions: In cured PVO, the clinical features vary depending on the location of major structural damage of PVO lesion. The involvement of intervertebral structure is related with sustained back pain and elevation of CRP, and vertebral body/paravertebral muscle shows favorable clinical features despite advanced structural damages.

scholarly journals Microbial Etiology of Pyogenic Vertebral Osteomyelitis According to Patient Characteristics

2020 ◽  
Vol 7 (6) ◽  
Author(s):  
Dong Youn Kim ◽  
Uh Jin Kim ◽  
Yohan Yu ◽  
Seong-Eun Kim ◽  
Seung-Ji Kang ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Vertebral Osteomyelitis ◽  
Patient Characteristics ◽  
Old Patients ◽  
Specific Patient ◽  
Gram Negative ◽  
Microbial Etiology ◽  
Pyogenic Vertebral Osteomyelitis ◽  
Empirical Antibiotics ◽  
Culture Negative

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 &lt; .05), in patients with cirrhosis than in those without (32.7% vs 21.1%; P &lt; .05), and in patients with a solid tumor than in those without (31.0% vs 20.7%; P &lt; .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 &lt; .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.

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

2015 ◽  
Vol 47 (11) ◽  
pp. 783-788 ◽  
Author(s):  
Derya Seyman ◽  
Hande Berk ◽  
Nevgun Sepın-Ozen ◽  
Fılız Kızılates ◽  
Cezmı Cagrı Turk ◽  
...  
Keyword(s):  
Vertebral Osteomyelitis ◽  
Pyogenic Vertebral Osteomyelitis ◽  
Culture Negative

scholarly journals 332. Spinal Infections: Clinical and Microbiological Characteristics in our Urban Referral Health Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S237-S238
Author(s):  
Osakpolor Ogbebor ◽  
Rasha Abdulmassih ◽  
James D Como ◽  
Nitin Bhanot
Keyword(s):  
Epidural Abscess ◽  
Vertebral Osteomyelitis ◽  
Positive Culture ◽  
Data Retrieval ◽  
Blood Cultures ◽  
Ct Guided ◽  
Microbiological Characteristics ◽  
Pathogen Recovery ◽  
Culture Positive ◽  
Spinal Infections

Abstract Background There has been an increasing trend in spinal infections (SI) in the U.S. over recent years. We sought to characterize the clinical and microbiological characteristics of SI at our hospital. Methods We conducted a retrospective review of SI over a 3-year period (2016 - 2019) utilizing ICD codes for data retrieval. Search terms included vertebral osteomyelitis, discitis, and epidural abscess. SPSS was used to compute the data. Results Of the initially screened 254 patients, 166 were included for analysis. Pertinent demographics were: mean age 59 years, male (61.4%), obese (44.5%), diabetic (25%), and drug-users (20%). Lumbosacral involvement was most common (69.8%); epidural abscess was present in 51.8% of patients. 15.7% had existing hardware. Overall, 79.5% (132/166) of cases had a positive culture from at least one site: blood 56.6% (94/166), CT-guided 83.5% (56/67), and surgical 51.1% (24/47). Of those patients with negative blood cultures, 22% (16/72) had pathogen recovery by CT-guided methods and 33% (24/72) from surgical specimens. S aureus was the most common pathogen isolated at 53.7% (71/132): MSSA comprised 38.6% (51/132) and MRSA 15.2% (20/132). The mean CRP (8.46 vs 15.83 mg/dL; P&lt; 0.001), and WBC (9.08 vs 13.18 k/mcL; P&lt; 0.001) were higher in culture-positive as compared to culture-negative cases. Mean ESR and temperature more than 100.4 oF did not differ significantly between these two groups. The 8-week median recurrence rate was 11.4%, of which nearly half had index S aureus bacteremia. Frequency of organisms isolated Association of mean inflammatory markers with positive cultures Conclusion Our study affirmed that S aureus is the most common cause of SI, of which MSSA was predominant. Epidural abscess was encountered in a substantial fraction of our case population. Leukocytosis and elevated CRP tended to predict culture-positive infection, whereas ESR and fever did not. As recommended in the IDSA Vertebral Osteomyelitis guidelines, blood cultures were obtained in all cases, which yielded positive results in more than half of patients. Pathogen recovery was further improved to nearly 80% with supplemental deep tissue sampling, thus highlighting the opportunity to enhance microbiological diagnosis at our institution. Disclosures All Authors: No reported disclosures

scholarly journals Validity of Clinical Assessment Using Clinical Symptoms and C-Reactive Protein for Therapeutic Response in Pyogenic Vertebral Osteomyelitis: Analysis Based on 18F-FDG-PET

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 809
Author(s):  
Ikchan Jeon ◽  
Dongwoo Yu ◽  
Eunjung Kong
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Assessment ◽  
Fdg Pet ◽  
Therapeutic Response ◽  
Clinical Symptoms ◽  
Vertebral Osteomyelitis ◽  
Parenteral Antibiotic ◽  
Reactive Protein ◽  
Pyogenic Vertebral Osteomyelitis ◽  
18F Fdg

Backgroundand objectives: The clinical assessment of therapeutic response in pyogenic vertebral osteomyelitis (PVO) has been usually performed based on the changes of clinical symptoms and blood inflammatory markers. Recently, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) has emerged as an alternative independent method. We analyzed the validity of the clinical assessment for detecting residual PVO based on 18F-FDG-PET. Materials and Methods: This study was conducted with 53 patients confirmed as lumbar PVO under retrospective design. All patients underwent clinical assessment using clinical symptoms and C-reactive protein (CRP) for therapeutic response after parenteral antibiotic therapy, which led to the decision of placement in the uncontrolled (group UC) or controlled (group C) group. The validity of clinical assessment was analyzed based on the cut-off values of FDG uptake for detecting residual PVO as references, which are already established in the previous literature. Results: The mean duration of parenteral antibiotic therapy and recurrence rate were 42.19 ± 15.84 (21–89) days and 9.4% (5/53), respectively. 18F-FDG-PETs were performed at 80 rounds of clinical assessment on 37.40 ± 13.15 (21–83) days of parenteral antibiotic therapy and divided: 31 into group UC and 49 into group C, according to the decisions of clinical assessment. Based on the cut-off values of FDG uptake, clinical assessment showed 48.4–58.1% of false positive for residual PVO in group UC. However, 18F-FDG-PET showed 8.2% (4/49) of false negative for residual PVO in group C, which led to recurrences. Conclusions: Clinical assessment using clinical symptoms and CRP for evaluating therapeutic response in PVO is still a useful method in terms of similar recurrence rate compared to 18F-FDG-PET. However, the high rate of false positive for residual PVO can prolong the use of unnecessary antibiotics and overall treatment period.

scholarly journals Long-Term Outcome of Pyogenic Vertebral Osteomyelitis: A Cohort Study of 260 Patients

2014 ◽  
Vol 1 (3) ◽  
Author(s):  
Arjun Gupta ◽  
Todd J. Kowalski ◽  
Douglas R. Osmon ◽  
Mark Enzler ◽  
James M. Steckelberg ◽  
...  
Keyword(s):  
Cohort Study ◽  
Back Pain ◽  
Treatment Failure ◽  
Vertebral Osteomyelitis ◽  
Term Outcome ◽  
Duration Of Symptoms ◽  
Long Term Outcome ◽  
Increased Risk ◽  
Pyogenic Vertebral Osteomyelitis

Abstract Background.  The long-term outcome of patients with pyogenic vertebral osteomyelitis (PVO) has not been fully assessed. Methods.  We conducted a retrospective cohort study to describe the long-term outcome of PVO and to assess risk factors for treatment failure in patients evaluated at our institution between 1994 and 2002. Patients were observed until July 1, 2013. Results.  Two hundred sixty patients with PVO were included in this study. Twenty-seven percent (70) of patients developed their infection after an invasive spinal procedure. Staphylococcus aureus accounted for 40% (103) of infections. Forty-nine percent (128) of patients underwent spinal surgery as part of their initial therapy. The median duration of parenteral antimicrobial therapy was 42 days (interquartile range, 38–53). The estimated 2-, 5-, and 10-year cumulative probability of treatment failure-free survival was 72%, 69%, and 69%, respectively. Seventy-five percent of patients who developed treatment failure did so within 4.7 months of diagnosis. Residual neurological defects and persistent back pain were seen in 16% and 32% of patients, respectively. In a multivariate analysis, longer duration of symptoms before diagnosis and having an infection with S. aureus were associated with increased risk of treatment failure. Conclusions.  Increasing duration of symptoms and infection with S. aureus were associated with treatment failure in patients with PVO. Most treatment failures occurred early after initiation of treatment. Pyogenic vertebral osteomyelitis is associated with a high 2-year failure rate. Persistent neurological deficits and back pain are common after therapy.

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