Hematogenous vertebral osteomyelitis due to Staphylococcus aureus in the adult: clinical features and therapeutic outcomes.
OBJECTIVE
Staphylococcus aureus is the most common cause of hematogenous vertebral osteomyelitis in adults. To better define clinical features and therapeutic outcomes, the charts of 40 adult patients with S aureus hematogenous vertebral osteomyelitis were retrospectively reviewed.


METHODS
Retrospective chart review using standardized data collection form.


RESULTS
S aureus hematogenous vertebral osteomyelitis commonly occurred in the settings of recent invasive procedures (55% of patients), insulin use (28%), and hemodialysis (20%). Ten percent of patients had S aureus bacteremia or vascular catheter infection within the preceding 6 months. Median time from first symptom to diagnosis was 51.3 days. A portal of entry for S aureus was identified in 13 patients (32.5%); intravenous catheters were the likely origin in 9 of those 13 patients. Concurrent endocarditis was present in 4 patients. Forty-eight percent of patients had neurologic abnormalities and 60% of patients had an epidural, paraspinous, or psoas abscess demonstrated by neuroimaging. S aureus was isolated through fine-needle aspiration in 17 of 23 patients (74%) and from blood cultures in 23 of 34 patients (68%). Infection was due to methicillin-susceptible S aureus in 67.5% of patients. All patients received intravenous antibiotics for a mean duration of 58.6 days; 36 of 40 (90%) also received concomitant rifampin. Twenty-seven percent and 12.5% of patients underwent surgical debridement and CT-guided drainage of abscesses, respectively. After intravenous therapy, 19 of 30 eligible patients received oral continuation treatment. The mean duration of total antibiotic therapy was 142.2 days.


CONCLUSIONS
Cure of infection was achieved in 83% (24/29) of evaluable patients, but 50% of those achieving cure still had infection-related sequelae. Intravenous antibiotic therapy for at least 8 weeks was the only clinical factor associated with cure (P = 0.05, two-tailed Fisher exact test).
Priest
David H
DH
Section on Infectious Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
Peacock
James E
JE
D000038:Abscess / Q000382:microbiology; D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000382:microbiology; D001799:Blood Sedimentation; D003646:Debridement; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D004322:Drainage; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D007964:Leukocytosis / Q000175:diagnosis; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality / Q000628:therapy; D006435:Renal Dialysis; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality / Q000628:therapy; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D013211:Staphylococcus aureus
D000900:Anti-Bacterial Agents