Outcomes of treatment for hematogenous Staphylococcus aureus vertebral osteomyelitis in the MRSA ERA.
OBJECTIVE
Hematogenous vertebral osteomyelitis is caused predominantly by Staphylococcus aureus. The rise in incidence of methicillin-resistant S. aureus (MRSA) has complicated the treatment of this infection. Our objective was to evaluate therapeutic outcomes for S. aureus vertebral osteomyelitis in a setting of high MRSA prevalence.


METHODS
We conducted a retrospective chart review of all patients who presented with S. aureus vertebral osteomyelitis over a 7-year period at 2 tertiary care hospitals in Houston, TX, USA.


RESULTS
Thirty-five patients were identified who received > or =2-week course of parenteral antibiotics and had a follow-up period of at least 12 months post-therapy. MRSA was responsible for 20 (57%) cases. Mean duration of total antibiotic therapy was 61.4 days. The overall relapse rate was 14%. At 12 months post-therapy, 86% patients were cured. The one factor significantly associated with relapse was presence of undrained abscesses (p=0.04).


CONCLUSIONS
When the mean duration of effective antibiotic therapy was 60 days, cure rates for S. aureus vertebral osteomyelitis exceeded 80%. Drainage of all associated abscesses correlated with a significantly higher rate of cure.
Section of Infectious Diseases, Baylor College of Medicine, One Baylor Plaza, BCM 286, N1319, Houston, TX 77030, USA. dlivorsi@alumni.rice.edu
Daniel J
DJ
Livorsi
Naval G
NG
Daver
Robert L
RL
Atmar
Samuel A
SA
Shelburne
A Clinton
AC
White
Daniel M
DM
Musher
D000038:Abscess / Q000382:microbiology*; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016470:Bacteremia / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D010019:Osteomyelitis / Q000188:drug therapy*; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000382:microbiology / Q000628:therapy; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000187:drug effects; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents