title: Clinical features, outcomes, and survival factor in patients with vertebral osteomyelitis infected by methicillin-resistant staphylococci.
abstract: OBJECTIVE
  To elucidate clinico-radiological features, therapeutic outcomes, and survival factors of vertebral osteomyelitis patients infected by methicillin-resistant staphylococci (MRS).
  
  
  METHODS
  Vertebral osteomyelitis patients admitted to the orthopaedic department between 2007 and 2011 (n = 248) were selected for this multicenter study. We compared patients' backgrounds, therapeutic course, and in-hospital mortality between MRS and methicillin-susceptible staphylococci (MSS). We also examined survival factors of vertebral osteomyelitis due to MRS.
  
  
  RESULTS
  Sixteen patients of MRS vertebral osteomyelitis and 55 patients of MSS were included in this study. In MRS vertebral osteomyelitis, the rates of comorbid diabetes mellitus, involvement of >2 vertebral bodies, in-hospital mortality, and operation of surgical debridement were higher compared to those in MSS vertebral osteomyelitis. Univariate analysis showed that operation of surgical debridement was a factor related to survival in MRS patients.
  
  
  CONCLUSIONS
  Higher rate of comorbid diabetes mellitus, involvement of >2 vertebral bodies, in-hospital mortality, and performing surgical debridement are peculiar features of MRS vertebral osteomyelitis compared to MSS vertebral osteomyelitis. If patients with MRS vertebral osteomyelitis respond poorly to antibiotic therapy, it might be better to consider surgical debridement not to lose an opportunity of operation due to exacerbation of systemic conditions.
authors.affiliation: Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Asahimachidori 1-757, Chuo-ku, Niigata-shi 951-8510, Japan. Electronic address: xmbdn983@ybb.ne.jp.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Shoji
authors.affiliation: Department of Orthopedic Surgery, Tsuruoka Municipal Shonai Hospital, Izumimachi 4-20, Tsuruoka-shi 997-8515, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Urakawa
authors.affiliation: Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Asahimachidori 1-757, Chuo-ku, Niigata-shi 951-8510, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Asahimachidori 1-757, Chuo-ku, Niigata-shi 951-8510, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Hirano
authors.affiliation: Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Asahimachidori 1-757, Chuo-ku, Niigata-shi 951-8510, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Katsumi
authors.affiliation: Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Asahimachidori 1-757, Chuo-ku, Niigata-shi 951-8510, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohashi
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Shibata Hospital, Honcho 1-2-8, Shibata-shi 957-8588, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sato
authors.affiliation: Spine Center, Department of Orthopedic Surgery, Niigata Central Hospital, Shinkocho 1-18, Chuo-ku, Niigata-shi 950-8556, Japan.
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Yamazaki
authors.affiliation: Department of Orthopedic Surgery, Nagaoka Chuo General Hospital, Kawasakimachi 2041, Nagaoka-shi 940-8653, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Yajiri
authors.affiliation: Department of Orthopedic Surgery, Niigata Rosai Hospital, Touncho 1-7-12, Joetsu-shi 942-8502, Japan.
authors.forename: Ren
authors.initials: R
authors.lastname: Kikuchi
authors.affiliation: Department of Orthopedic Surgery, Niigata Prefectural Central Hospital, Shinnancho 205, Joetsu-shi 943-0192, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Hosaka
authors.affiliation: Department of Orthopedic Surgery, Niigata City General Hospital, Shumoku 463-7, Chuo-ku, Niigata-shi 950-1197, Japan.
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Sawakami
authors.affiliation: Department of Orthopedic Surgery, Tachikawa General Hospital, Kandamachi 3-2-11, Nagaoka-shi 940-8621, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Miura
authors.affiliation: Department of Orthopedic Surgery, Tominaga-Kusano Orthopedic Hospital, Kouya 2-2-25, Sanjo-shi 955-0046, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakamura
authors.affiliation: Department of Orthopedic Surgery, Tsuruoka Municipal Shonai Hospital, Izumimachi 4-20, Tsuruoka-shi 997-8515, Japan.
authors.forename: Ryuta
authors.initials: R
authors.lastname: Fujikawa
authors.affiliation: Department of Orthopedic Surgery, Nagaoka Chuo General Hospital, Kawasakimachi 2041, Nagaoka-shi 940-8653, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Wakasugi
authors.affiliation: Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Asahimachidori 1-757, Chuo-ku, Niigata-shi 951-8510, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Endo
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002423:Cause of Death; D016208:Databases, Factual; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013131:Spine / Q000000981:diagnostic imaging / Q000382:microbiology; D013166:Spondylitis / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000401:mortality* / Q000628:therapy; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy; D018709:Statistics, Nonparametric; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents