title: Therapeutic outcomes of hematogenous vertebral osteomyelitis with instrumented surgery.
abstract: BACKGROUND
  Patients with hematogenous vertebral osteomyelitis (HVO) occasionally require instrumentation for spinal stabilization. However, placing instrumentation in the setting of spinal infection raises concerns about recurrent infection due to bacteria adhering to the foreign material. In this study, we evaluated the therapeutic outcomes of patients with HVO who underwent instrumented surgery.
  
  
  METHODS
  We conducted a retrospective chart review of adult patients with microbiologically diagnosed HVO who underwent surgical intervention in 5 tertiary care hospitals over an 8-year period.
  
  
  RESULTS
  A total of 153 patients with HVO underwent surgical management for their infections. Of these 153 patients, 94 (61.4%) underwent surgical debridement alone (noninstrumented surgery) and 59 (38.6%) underwent surgical debridement and instrumentation (instrumented surgery). The median durations of antibiotic therapy were 66 and 80 days for the noninstrumentation and instrumentation groups, respectively (P = .22). Clinical outcomes were similar between the groups, including rates of infection-related death (2.1% vs 0%; P = .52), primary failure (1.1% vs 5.1%; P = .30), and recurrence (4.8% vs 6.8%; P = .72). Among the instrumentation group, there was a significant decreasing trend for recurrence according to total duration of antibiotic therapy: 22.2% (4-6 weeks), 9.1% (6-8 weeks), and 2.6% (≥ 8 weeks; P = .04). Duration of pre-instrumentation antibiotic therapy and single-stage operation (vs 2-stage operation) were not risk factors for recurrence.
  
  
  CONCLUSIONS
  Spinal instrumentation in patients with HVO may be safe with pathogen-directed prolonged antibiotic therapy and should not be abandoned or delayed solely because of the risk of recurrence.
authors: Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul.
authors: Ki-Ho
authors: KH
authors: Park
authors: Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju.
authors: Oh-Hyun
authors: OH
authors: Cho
authors: Department of Infectious Diseases, Busan Paik Hospital, Inje University College of Medicine, Busan.
authors: Yu-Mi
authors: YM
authors: Lee
authors: Department of Infectious Diseases, Busan Paik Hospital, Inje University College of Medicine, Busan.
authors: Chisook
authors: C
authors: Moon
authors: Department of Internal Medicine, Dongguk University Ilsan Hospital, University of Dongguk College of Medicine, Goyang-si.
authors: Seong Yeon
authors: SY
authors: Park
authors: Department of Infectious Diseases, Gachon University Gil Medical Center, Incheon.
authors: Song Mi
authors: SM
authors: Moon
authors: Department of Orthopaedic Surgery.
authors: Jung Hee
authors: JH
authors: Lee
authors: Department of Radiology, Kyung Hee University Hospital, Kyung Hee University School of Medicine.
authors: Ji Seon
authors: JS
authors: Park
authors: Department of Radiology, Kyung Hee University Hospital, Kyung Hee University School of Medicine.
authors: Kyung Nam
authors: KN
authors: Ryu
authors: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors: Sung-Han
authors: SH
authors: Kim
authors: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors: Sang-Oh
authors: SO
authors: Lee
authors: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors: Sang-Ho
authors: SH
authors: Choi
authors: Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul.
authors: Mi Suk
authors: MS
authors: Lee
authors: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors: Yang Soo
authors: YS
authors: Kim
authors: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors: Jun Hee
authors: JH
authors: Woo
authors: Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju.
authors: In-Gyu
authors: IG
authors: Bae
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000382:microbiology / Q000601:surgery*; D019736:Prostheses and Implants; D012008:Recurrence; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000601:surgery*; D013131:Spine / Q000382:microbiology / Q000601:surgery*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000517:prevention & control / Q000601:surgery; D013211:Staphylococcus aureus / Q000302:isolation & purification; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic; outcome; spondylitis; treatment; vertebral osteomyelitis