title: Hematogenous vertebral osteomyelitis associated with intravascular device-associated infections - A retrospective cohort study.
abstract: BACKGROUND
  Aim of the study was to investigate the clinical, microbiological, radiological, and treatment characteristics of hematogenous vertebral osteomyelitis originating from infected intravascular devices.
  
  
  METHODS
  Patients with secondary hematogenous vertebral osteomyelitis caused by an infected intravascular device were included in this retrospective cohort study. Patients with prior spinal surgery were excluded. Categorical variables were compared using χ2or Fisher's exact tests and continuous variables using the Mann-Whitney U test.
  
  
  RESULTS
  Sixty-seven patients with hematogenous vertebral osteomyelitis were included. Intravenous catheters were the source of infection in 45 patients (67%) and cardiovascular devices in 22 (33%). Fever was present in 21 patients (45%). The main pathogens were coagulase-negative staphylococci, isolated in 42 patients (63%), which grew from blood culture in 52 patients (87%), from vertebral tissue in 29 patients (56%) and from the explanted intravascular device in 18 patients (60%), where it was sampled. Infective endocarditis was diagnosed in 14 of 45 patients (31%), more common with cardiovascular devices than with intravascular catheters (56% versus 15%; P=0.008).
  
  
  CONCLUSIONS
  In patients with vertebral osteomyelitis, growth of coagulase-negative staphylococci in blood is highly suggestive for intravascular device-associated infection. Despite absence of systemic or local signs of inflammation at the site of the device, blood cultures should be collected and echocardiography performed in these patients.
authors.affiliation: Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, D-10117 Berlin, Germany; Berlin Institute of Health, Berlin, Kapelle-Ufer 2, D-10117 Berlin, Germany. Electronic address: nora.renz@charite.de.
authors.forename: Nora
authors.initials: N
authors.lastname: Renz
authors.affiliation: Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, D-10117 Berlin, Germany.
authors.forename: Judith
authors.initials: J
authors.lastname: Haupenthal
authors.affiliation: Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, D-10117 Berlin, Germany.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Schuetz
authors.affiliation: Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Charitéplatz 1, D-10117 Berlin, Germany; Berlin Institute of Health, Berlin, Kapelle-Ufer 2, D-10117 Berlin, Germany.
authors.forename: Andrej
authors.initials: A
authors.lastname: Trampuz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D001769:Blood / Q000382:microbiology; D000071997:Blood Culture; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants / Q000009:adverse effects*; D012189:Retrospective Studies; D013166:Spondylitis / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D062666:Vascular Access Devices / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Cardiac implantable electronic devices; Coagulase-negative staphylococci; Hematogenous; Intravascular catheter; Vertebral osteomyelitis