title: Changing trends in the epidemiology of vertebral osteomyelitis in Marseille, France.
abstract: The incidence and significant morbidity of vertebral osteomyelitis are increasing despite the progress of diagnosis competences. Among the 50 cases of vertebral osteomyelitis managed in our centers over the past 5 years, 84% of the cases were in men. The mean age was 55 years. Sixty-two percent of patients had comorbidities and risk factors: diabetes mellitus (24%), malignancy (16%), intravenous drug use (10%) and alcoholism (4%). A source of infection was identified in 66% of cases, including postvertebral surgery infection (18%) and hematogenous infection (48%). The mean time to diagnosis was 36 days. Back pain were occurred in 90% of cases, fever (70%), neurologic deficits (40%), epidural abscesses (32%), completed vertebral bone destruction (26%) and psoas abscess (12%). A single organism was isolated in 92% of cases. Gram-positive bacteria were identified in 76% of cases, while Gram-negative bacilli (GNB) were found in 18% of cases. The presence of GNB was significantly associated with malignancy (p 0.041). The mean duration of antibiotic therapy was 123 days. Surgical treatment was performed in 41 cases: spinal stabilization (26%), drainage of abscesses (32%) and relief of compression (40%). Residual pain was found in 24% of cases, and neurologic sequelae in 22%. Cervical or thoracic localization was a risk factor for neurologic compromise (p 0.042). The epidemiology of vertebral osteomyelitis has changed; an increase in malignancy that was significantly associated with vertebral osteomyelitis due to GNB has been observed. Our study shows that the rate of neurologic complications remains high despite improved diagnostic capabilities and optimal treatment.
authors.affiliation: Centres de référence interrégionaux Sud-Méditerranée pour la prise en charge des Infections Ostéo-Articulaires complexes, Service des maladies infectieuses, CHU de la Conception, 147, boulevard Baille, Marseille, France.
authors.forename: Mahamadou
authors.initials: M
authors.lastname: Doutchi
authors.affiliation: Centres de référence interrégionaux Sud-Méditerranée pour la prise en charge des Infections Ostéo-Articulaires complexes, Service des maladies infectieuses, CHU de la Conception, 147, boulevard Baille, Marseille, France ; Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France ; Institut Hospitalo-Universitaire Méditerranée Infection, Pôle Infectieux, Assistance Publique des Hôpitaux de Marseille, 13005 Marseille, France.
authors.forename: Piseth
authors.initials: P
authors.lastname: Seng
authors.affiliation: Centres de référence interrégionaux Sud-Méditerranée pour la prise en charge des Infections Ostéo-Articulaires complexes, Service des maladies infectieuses, CHU de la Conception, 147, boulevard Baille, Marseille, France ; Institut Hospitalo-Universitaire Méditerranée Infection, Pôle Infectieux, Assistance Publique des Hôpitaux de Marseille, 13005 Marseille, France.
authors.forename: Amélie
authors.initials: A
authors.lastname: Menard
authors.affiliation: Centres de référence interrégionaux Sud-Méditerranée pour la prise en charge des Infections Ostéo-Articulaires complexes, Service des maladies infectieuses, CHU de la Conception, 147, boulevard Baille, Marseille, France.
authors.forename: Line
authors.initials: L
authors.lastname: Meddeb
authors.affiliation: Service de Neurochirurgie, CHU de la Timone, Marseille, France.
authors.forename: Tarek
authors.initials: T
authors.lastname: Adetchessi
authors.affiliation: Service de Neurochirurgie, CHU de la Timone, Marseille, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Fuentes
authors.affiliation: Service de Neurochirurgie, CHU de la Timone, Marseille, France.
authors.forename: Henry
authors.initials: H
authors.lastname: Dufour
authors.affiliation: Centres de référence interrégionaux Sud-Méditerranée pour la prise en charge des Infections Ostéo-Articulaires complexes, Service des maladies infectieuses, CHU de la Conception, 147, boulevard Baille, Marseille, France ; Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France ; Institut Hospitalo-Universitaire Méditerranée Infection, Pôle Infectieux, Assistance Publique des Hôpitaux de Marseille, 13005 Marseille, France.
authors.forename: Andreas
authors.initials: A
authors.lastname: Stein
keywords: Epidemiology of bacteria; human; malignancy; spondylodiscitis; vertebral osteomyelitis