The participants in this study were those who were already alive when the data was collected. The goal was to evaluate the impact of 2 prevalent infections responsible for vertebral osteomyelitis (VO) on treatment failure in the first year following diagnosis. Staphylococcus aureus (SA) is the leading cause of VO, but enterococci (EC) and streptococcus (ST) are also major contributors, especially in the elderly. There is a trend toward a poorer prognosis in data on VO produced by SA, while data on VO caused by ENST are rare. To identify predictors of treatment failure, researchers examined the demographics of individuals with VO due to SA and ENST. From 2008-2020, they gathered data from VO patients in a single-center study. Treatment failure, measured as death or relapse within a year, was the primary outcome of interest (T1). Patients diagnosed with VO due to Staphylococcus aureus (including MRSA) were compared to patients diagnosed with VO due to Enterococcus and Streptococcus species (together referred to as “VO due to other organisms’’). There was no evidence of a polymicrobial infection. To account for any confounding factors they used a multivariate logistic regression model to account for any confounding factors. An additional interaction variable was incorporated into the model in a second run to account for moderating. At T1, information was provided for 130 VO patients (SA=95; ENST=35). Approximately 37% of SA patients and 23% of ENST patients experienced treatment failure. Treatment failure was associated with sarcoidosis (OR 3.12, 95% CI 1.09-10.53, P=0.046), the Charlson comorbidity index (OR 1.31, 95% CI 1.11-1.58, P=0.002), and infective endocarditis (IE; OR 4.29, 95% CI 1.23-15.96, P=0.024) in a multivariate analysis. Every third patient in the cohort with SA or ENST-induced VO died within a year. In light of the results, they hypothesized that patients with SA-related VO, coexisting IE, and/or a high Charlson comorbidity index score might be at a greater risk for treatment failure. These results can guide clinical surveillance and help customize treatment plans for particular patients. When gram-positive infections are suspected in cases with VO, an echocardiogram may be performed to rule in or rule out IE.

 

Source: journals.lww.com/spinejournal/Abstract/2022/10150/Treatment_Failure_in_Vertebral_Osteomyelitis__Is.9.aspx