title: Clinical characteristics and outcomes of hematogenous vertebral osteomyelitis caused by gram-negative bacteria.
abstract: OBJECTIVE
  To evaluate the clinical characteristics and outcomes of patients with hematogenous vertebral osteomyelitis (HVO) caused by gram-negative bacteria (GNB).
  
  
  METHODS
  We conducted a retrospective chart review of adult patients with HVO from three tertiary-care hospitals over a 7-year period.
  
  
  RESULTS
  Of the 313 microbiologically diagnosed HVO cases, GNB was responsible for 65 (20.8%) cases. Compared with patients with MSSA HVO, patients with GNB HVO were more likely to be female (P = 0.03) and have diabetes (P = 0.03), but less likely to have epidural abscess (P = 0.02) and paravertebral abscess (P = 0.003). Clinical outcomes were similar between the GNB and MSSA groups, including in-hospital mortality (4.6% vs. 7.8%; P = 0.53), recurrence (9.7% vs. 4.3%; P = 0.20), and sequelae (31.7% vs. 32.2%; P = 0.95). Among GNB-infected patients, recurrence rates differed according to the total duration of antibiotic treatment: 40.0% (4-6 weeks), 33.3% (6-8 weeks), and 2.1% (≥ 8 weeks) (P = 0.002).
  
  
  CONCLUSIONS
  GNB HVO was responsible for 20.8% of adult cases of HVO. Despite some differences in clinical and radiological presentation, clinical outcomes were similar between GNB and MSSA HVO. Antibiotic therapy for ≥ 8 weeks may benefit patients with GNB HVO.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
authors.forename: Ki-Ho
authors.initials: KH
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
authors.forename: Oh Hyun
authors.initials: OH
authors.lastname: Cho
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
authors.forename: Myounghwa
authors.initials: M
authors.lastname: Jung
authors.affiliation: Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyung-Soo
authors.initials: KS
authors.lastname: Suk
authors.affiliation: Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jung Hee
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
authors.forename: Ji Seon
authors.initials: JS
authors.lastname: Park
authors.affiliation: Department of Radiology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
authors.forename: Kyung Nam
authors.initials: KN
authors.lastname: Ryu
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Sung-Han
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Sang-Oh
authors.initials: SO
authors.lastname: Lee
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Republic of Korea.
authors.forename: In-Gyu
authors.initials: IG
authors.lastname: Bae
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Yang Soo
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Jun Hee
authors.initials: JH
authors.lastname: Woo
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea. Electronic address: mslee@khmc.or.kr.
authors.forename: Mi Suk
authors.initials: MS
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy / Q000473:pathology*; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D013166:Spondylitis / Q000188:drug therapy / Q000473:pathology*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000473:pathology; D016019:Survival Analysis; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Gram-negative bacteria; Outcome; Spondylitis; Spondylodiscitis; Vertebral osteomyelitis