Diagnostic delay of pyogenic vertebral osteomyelitis and its associated factors.
OBJECTIVE
Pyogenic vertebral osteomyelitis (PVO) is a rare disease with possible severe complications (e.g. sepsis and spinal cord injury). In the 1990s, diagnostic delay (DD) was often extensive as PVO has a non-specific clinical spectrum, mostly afebrile with back pain, and access to magnetic resonance imaging (MRI) was not straightforward. Our aim was to perform a new study focusing on the clinical spectrum and DD of PVO and its associated factors.


METHODS
This study examined a prospective cohort of 88 patients having PVO with microbiological identification between 15 November 2006 and 15 November 2010.


RESULTS
The 88 patients included in the study (female:male ratio 1:8) had a mean age of 64.1 years. The mean (sd) DD was 45.5 (50.4) days (range 2-280), and 46 patients (52.2%) were febrile at diagnosis. The main microorganism involved was Staphylococcus (n = 45; 51.1%). In univariate and multivariate analyses, age > 75 years, antecedent back pain, involvement of bacteria, topography of PVO, and anti-inflammatory drug intake did not affect the DD, unlike a C-reactive protein (CRP) value > 63 mg/L or a positive blood culture (DD lowered from 73 to 17 days and from 90 to 30 days, respectively). Conversely, X-ray investigation was associated with a longer DD (from 14 to 34.7 days). Severity at diagnosis was not significantly different depending on the intake of anti-inflammatory drugs.


CONCLUSIONS
Despite easier access to MRI, the DD for PVO remains long. One shortening factor is a high CRP value, which could be a useful diagnostic tool in case of back pain. Anti-inflammatory drugs seem to have no impact on DD and severity at diagnosis.
a Infectious Diseases Department , University Hospital of Paris, CHU Raymond Poincaré, APHP, Garches Versailles Saint Quentin University , France.
M
M
Jean
b Sorbonne University, UPMC University of Paris 06, UMR 7093, LOV , F-06230 , Villefranche/mer , France.|c CNRS, UMR 7093, LOV , F-06230 , Villefranche/mer , France.
J-O
JO
Irisson
d Infectious Diseases Department , University Hospital of Tours, CHU Bretonneau, Denis Diderot University , France.
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G
Gras
e Pharmacy , University Hospital of Paris, CHU R. Poincaré, APHP, Garches Versailles Saint Quentin University , France.
F
F
Bouchand
d Infectious Diseases Department , University Hospital of Tours, CHU Bretonneau, Denis Diderot University , France.
D
D
Simo
a Infectious Diseases Department , University Hospital of Paris, CHU Raymond Poincaré, APHP, Garches Versailles Saint Quentin University , France.
C
C
Duran
a Infectious Diseases Department , University Hospital of Paris, CHU Raymond Poincaré, APHP, Garches Versailles Saint Quentin University , France.
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C
Perronne
f Department of Rheumatology Department , University Hospital of Tours, Trousseau, Denis Diderot University , France.
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D
Mulleman
d Infectious Diseases Department , University Hospital of Tours, CHU Bretonneau, Denis Diderot University , France.
L
L
Bernard
a Infectious Diseases Department , University Hospital of Paris, CHU Raymond Poincaré, APHP, Garches Versailles Saint Quentin University , France.
A
A
Dinh
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis*; D011446:Prospective Studies; D013122:Spinal Diseases / Q000175:diagnosis*