title: Prognostic Factors for Failure of Antibiotic Treatment in Patients With Osteomyelitis of the Spine.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  The aim of this study was to identify factors independently associated with antibiotic treatment failure in patients with spinal osteomyelitis.
  
  
  BACKGROUND
  There are few studies that have identified risk factors for antibiotic treatment failure in medically managed spinal osteomyelitis. Identifying such factors could help to identify patients who can be treated solely with antibiotics.
  
  
  METHODS
  All patients who underwent antibiotic treatment for spinal osteomyelitis in one of our institutions between January 1, 2001 and January 1, 2015 were identified. Patients who underwent surgery before the start of the antibiotic treatment were excluded.
  
  
  RESULTS
  We included 215 patients with a mean age of 58 years; 63 (29%) patients had failure of antibiotic treatment. Diabetes (hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.03-2.79, P = 0.037), fever (HR 1.61, 95% CI 0.93-2.79, P = 0.088), osteomyelitis at an additional site (HR 5.17, 95% CI 2.63-27.9, P = 0.001), and the presence of an epidural abscess (HR 1.91, 95% CI 1.05-3.45, P = 0.033) were associated with failure of antibiotic treatment. In the multivariate Cox regression analysis, diabetes (HR 1.69, 95% CI 1.03-2.79, P = 0.019), osteomyelitis at an additional site (HR 8.26, 95% CI 2.51-27.2, P = 0.001), fever (HR 1.77, 95% CI 1.00-3.12, P = 0.050), and the presence of an epidural abscess (HR 1.82, 95% CI 1.06-3.13, P = 0.030) were independently associated with failure of antibiotic treatment.
  
  
  CONCLUSIONS
  Antibiotic treatment failed in 29% of patients; diabetes, current other osteomyelitis, and having an epidural abscess were independently associated with failure of antibiotic treatment.
  
  
  METHODS
  3.
authors.affiliation: Department of Orthopaedic Surgery, Spine Surgery Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Jan Jaap
authors.initials: JJ
authors.lastname: de Graeff
authors.affiliation: Department of Orthopaedic Surgery, Spine Surgery Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Nuno Rui
authors.initials: NR
authors.lastname: Paulino Pereira
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Olivier D
authors.initials: OD
authors.lastname: van Wulfften Palthe
authors.affiliation: Department of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Nelson
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Spine Surgery Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Schwab
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents