title: The impact of bacteremia on the outcome of bone infections.
abstract: We have used a medical database to analyze our activity since 2005. We observed a frequent association between bone and joint infection (BI) and bacteremia. Our aim was to characterize patients with BI and bacteremia, and focus on the outcome.
  
  
  METHODS
  Our database includes the prospective recording of 28 characteristics of all hospitalized patients, including diagnosis, comorbid conditions, microbiological data, therapy, and outcome. We selected patients presenting with BI in this database, from July 2005 to December 2012. Fever before blood culture was retrospectively documented from the patient's chart. Chronic BI was defined as a disease lasting more than 1 month. An unfavorable outcome was defined by the need for intensive care or death.
  
  
  RESULTS
  Six hundred and thirty-two patients presented with BI and 125 with bacteremia (19.8%). We used a stepwise logistic regression analysis and determined that bacteremia was associated with vertebral osteomyelitis, OR, 3.97, P<0.001; alcohol abuse, OR, 2.51, P=0.010; fever, OR, 2.43, P<0.001; neurological and/or psychiatric diseases, OR, 2.41, P ≤ 0.001; and Staphylococcus aureus infection, OR, 2.32, P<0.001. The outcome was unfavorable in 23 cases (3.6%), associated with bacteremia, OR, 8.00, P<0.001, age> 60 years, OR, 4.78, P=0.018, and S. aureus infection, OR, 3.96, P=0.010. No single comorbid condition was significantly associated with an unfavorable outcome.
  
  
  CONCLUSIONS
  Bacteremia occurred in nearly 20% of the patients presenting with BI, and was associated with identifiable comorbid conditions; it was the main risk factor for an unfavorable outcome.
authors.affiliation: Infectious diseases, CHU de Nice, Université de Nice Sophia-Antipolis, 06202 Nice, France. Electronic address: roger.pm@chu-nice.fr.
authors.forename: P-M
authors.initials: PM
authors.lastname: Roger
authors.affiliation: Infectious diseases, CHU de Nice, Université de Nice Sophia-Antipolis, 06202 Nice, France.
authors.forename: E
authors.initials: E
authors.lastname: Cua
authors.affiliation: Infectious diseases, CHU de Nice, Université de Nice Sophia-Antipolis, 06202 Nice, France.
authors.forename: J
authors.initials: J
authors.lastname: Courjon
authors.affiliation: Bacteriology, CHU de Nice, Université de Nice Sophia-Antipolis, 06202 Nice, France.
authors.forename: L
authors.initials: L
authors.lastname: Landraud
authors.affiliation: Anesthesiology-Intensive Care, CHU de Nice, Université de Nice Sophia-Antipolis, 06202 Nice, France.
authors.forename: M
authors.initials: M
authors.lastname: Carles
authors.affiliation: Infectious diseases, CHU de Nice, Université de Nice Sophia-Antipolis, 06202 Nice, France.
authors.forename: E
authors.initials: E
authors.lastname: Bernard
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000150:complications*; D001847:Bone Diseases / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies
keywords: Bacteremia; Bactériémie; Bone infection; Infection ostéoarticulaire; Outcome; Pronostic; Staphylococcus