Vertebral Osteomyelitis After Spine Surgery: A Disease With Distinct Characteristics

STUDY DESIGN.Prospective cohort study. OBJECTIVE.We aimed to determine the 2-year survival and to identify clinical and microbiological characteristics of patients with native vertebral osteomyelitis (VO) as compared to postoperative VO to find further strategies for improvement of the management of...

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Published in:Spine (Philadelphia, Pa. 1976) Pa. 1976), 2020-10, Vol.45 (20), p.1426-1434
Main Authors: Breuninger, Marianne, Yagdiran, Ayla, Willinger, Anja, Biehl, Lena Maria, Otto-Lambertz, Christina, Kuhr, Kathrin, Seifert, Harald, Fätkenheuer, Gerd, Lehmann, Clara, Sobottke, Rolf, Siewe, Jan, Jung, Norma
Format: Article
Language:English
Subjects:
Adult
Aged
Bacteria
Cohort Studies
Comorbidity
Disease
Female
Humans
Male
Middle Aged
Osteomyelitis - epidemiology
Osteomyelitis - mortality
Postoperative Complications
Prospective Studies
Retrospective Studies
Spine - microbiology
Spine - surgery
Young Adult
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Summary:STUDY DESIGN.Prospective cohort study. OBJECTIVE.We aimed to determine the 2-year survival and to identify clinical and microbiological characteristics of patients with native vertebral osteomyelitis (VO) as compared to postoperative VO to find further strategies for improvement of the management of VO. SUMMARY OF BACKGROUND DATA.A relevant subgroup (20%–30%) of patients with VO has a history of spine surgery. Infection in these patients might be clinically different from native VO. However, clinical, microbiological, and outcome characteristics of this disease entity have not been well studied as most trials either excluded these patients or are limited by a small cohort and short observation period. METHODS.Between 2008 and 2013, patients who presented at a tertiary care center with symptoms and imaging findings suggestive of VO were reviewed by specialists in infectious diseases, clinical microbiology, and orthopedics to confirm the diagnosis and followed prospectively for a period of 2 years. Statistical analysis for group comparisons, survival analysis, and uni- and multivariable Cox regression models were performed. RESULTS.Thirty percent of the patients with VO (56/189) reported a history of spine surgery in the same segment. Patients with postoperative infection had a lower ASA score (American Society of Anesthesiologists) (P = 0.01) and were less likely to suffer from comorbidities compared to native cases (P = 0.003). Infections caused by coagulase-negative staphylococci (33.3 vs. 6.5%, P 
ISSN:0362-2436
1528-1159
DOI:10.1097/BRS.0000000000003542