title: Clinical characteristics and therapeutic outcomes of hematogenous vertebral osteomyelitis caused by methicillin-resistant Staphylococcus aureus.
abstract: OBJECTIVE
  To evaluate the clinical characteristics and therapeutic outcomes of patients with hematogenous vertebral osteomyelitis (HVO) caused by methicillin-resistant Staphylococcus aureus (MRSA).
  
  
  METHODS
  We performed a cohort study of adult patients diagnosed with S. aureus HVO at a tertiary-care hospital over a 7-year period.
  
  
  RESULTS
  Of the 139 patients with S. aureus HVO, MRSA caused 62 (44.6%) cases. In multivariate analysis, compared with methicillin-susceptible S. aureus (MSSA), MRSA was associated with a higher risk of persistent bacteremia (≥7 days) (8.40 fold; P < 0.001) and relapse (4.83 fold; P = 0.03), and increased hospital stay (1.69 fold; P = 0.001). Among the MRSA cases, relapse rates differed according to duration of antibiotics: 41.7% (4-6 weeks), 25.0% (6-8 weeks), and 5.6% (≥8 weeks) (P = 0.007). Bacteremia was more likely to persist for ≥7 days in patients with an initial vancomycin trough <15 mg/L than in those with an initial trough ≥15 mg/L (79.3% vs. 20.0%; P = 0.001).
  
  
  CONCLUSIONS
  MRSA HVO was associated with more frequent persistent bacteremia (≥7 days) and relapse, and longer hospital stay compared to MSSA HVO. Antibiotic therapy for ≥8 weeks and targeting a vancomycin trough of ≥15 mg/L may be benefit patients with MRSA HVO.
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea; Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea.
authors.forename: Ki-Ho
authors.initials: KH
authors.lastname: Park
authors.forename: Yong Pil
authors.initials: YP
authors.lastname: Chong
authors.forename: Sung-Han
authors.initials: SH
authors.lastname: Kim
authors.forename: Sang-Oh
authors.initials: SO
authors.lastname: Lee
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Mi Suk
authors.initials: MS
authors.lastname: Lee
authors.forename: Jin-Yong
authors.initials: JY
authors.lastname: Jeong
authors.forename: Jun Hee
authors.initials: JH
authors.lastname: Woo
authors.forename: Yang Soo
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy* / Q000382:microbiology*; D013122:Spinal Diseases / Q000188:drug therapy* / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology*; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Bacteremia; MRSA; Spondylitis; Staphylococcus aureus; Vertebral osteomyelitis