The epidemiology of hematogenous vertebral osteomyelitis: a cohort study in a tertiary care hospital.
BACKGROUND
Vertebral osteomyelitis is a common manifestation of osteomyelitis in adults and associated with considerable morbidity. Limited data exist regarding hematogenous vertebral osteomyelitis. Our objective was to describe the epidemiology and management of hematogenous vertebral osteomyelitis.


METHODS
We performed a 2-year retrospective cohort study of adult patients with hematogenous vertebral osteomyelitis at a tertiary care hospital.


RESULTS
Seventy patients with hematogenous vertebral osteomyelitis were identified. The mean age was 59.7 years (+/-15.0) and 38 (54%) were male. Common comorbidities included diabetes (43%) and renal insufficiency (24%). Predisposing factors in the 30 days prior to admission included bacteremia (19%), skin/soft tissue infection (17%), and having an indwelling catheter (30%). Back pain was the most common symptom (87%). Seven (10%) patients presented with paraplegia. Among the 46 (66%) patients with a microbiological diagnosis, the most common organisms were methicillin-susceptible S. aureus [15 (33%) cases], and methicillin-resistant S. aureus [10 (22%)]. Among the 44 (63%) patients who had a diagnostic biopsy, open biopsy was more likely to result in pathogen recovery [14 (93%) of 15 with open biopsy vs. 14 (48%) of 29 with needle biopsy; p = 0.003]. Sixteen (23%) patients required surgical intervention for therapeutic purposes during admission.


CONCLUSIONS
This is one of the largest series of hematogenous vertebral osteomyelitis. A microbiological diagnosis was made in only approximately two-thirds of cases. S. aureus was the most common causative organism, of which almost half the isolates were methicillin-resistant.
Bhavan
Kavita P
KP
Division of Infectious Diseases, Washington University School of Medicine, St, Louis, MO, USA.
Marschall
Jonas
J
Olsen
Margaret A
MA
Fraser
Victoria J
VJ
Wright
Neill M
NM
Warren
David K
DK
D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000150:complications; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D002408:Catheters, Indwelling / Q000009:adverse effects; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D010019:Osteomyelitis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D051437:Renal Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000150:complications; D013166:Spondylitis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy