794. Clinical Characteristics and Outcomes of Hematogenous Vertebral Osteomyelitis Caused by Gram-Negative Bacteria
Session: Poster Abstract Session: Bone and Joint
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 2013년 IDweek_GNB HVO (0.5배 축소판).pdf (3.0 MB)
  • Background: Hematogenous vertebral osteomyelitis (HVO) has increased in recent years. Our objective is to evaluate the clinical characteristics and therapeutic outcomes of patients with HVO caused by gram-negative bacteria.

    Methods: We conducted a retrospective chart review of all patients with microbiologically confirmed HVO over a 8-year period at 3 tertiary care hospitals in South Korea.

    Results: A total of 321 patients with microbiologically confirmed HVO were identified. Of the 321 patients, 67 (20.9%) had gram-negative organism isolated. The median age was 63.7 years and 39 (58.2%) were female. Common comorbidities included diabetes (35.8%), malignancy (9.0%), and liver cirrhosis (9.0%). Median time from first symptom to diagnosis was 14.0 days (interquartile range [IQR], 7–36). Presumed source of infection were identified in 42 patients (62.7%); urinary tract in 18 (69.2%) of 26 female patients and gastrointestinal tract in 12 (75.0%) of 16 male patients. The most commonly isolated pathogen was Escherichia coli (n = 32), followed by Klebsiella pneumoniae (n = 14), Salmonella enterica (n = 4), and Pseudomonas aeruginosa (n = 4). Fifty-four (80.6%) of isolates were susceptible to ciprofloxacin. Pathogens were more frequently isolated from open biopsy than from needle biopsy (81.3% [13/16] vs. 35.3% [6/17]; P = 0.008). Thirty patients (44.1%) and 8 patients (11.8%) underwent surgical debridement and percutaneous drainage of abscess, respectively. All patients received intravenous antibiotics for a median duration of 52 days (IQR, 33–81). After intravenous therapy, 38 (65.5%) of 58 eligible patients received oral antibiotics; oral fluoroquinolone was prescribed in 85.3% of patients infected with fluoroquinolone-susceptible organisms. The median duration of total antibiotic therapy was 88 days (IQR, 58–138). At 12 months post-therapy, 92.9% patients were cured and 7.1% experienced relapse. Relapse rates differed according to total duration of antibiotics: 33.3% (4–6 weeks), 25.0% (6–8 weeks), and 2.2% (≥8 weeks) (P= 0.03).

    Conclusion: Gram-negative bacteria was responsible for one fifths of HVO. Antibiotics therapy for at least 8 weeks was the only clinical predictor associated with cure. Oral fluoroquinolone may be useful therapeutic agents for prolonged antibiotic therapy in these patients.

    Myounghwa Jung, MD1, Ki-Ho Park, MD1, Oh-Hyun Cho, MD2, In-Gyu Bae, MD2, Sung-Han Kim, MD3, Sang-Oh Lee, MD3, Sang-Ho Choi, MD3, Yang Soo Kim, MD3, Jun Hee Woo, MD3 and Mi Suk Lee, MD1, (1)Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea, (2)Department of Infectious Diseases, Gyeongsang National University Hospital, Jinju, South Korea, (3)Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Disclosures:

    M. Jung, None

    K. H. Park, None

    O. H. Cho, None

    I. G. Bae, None

    S. H. Kim, None

    S. O. Lee, None

    S. H. Choi, None

    Y. S. Kim, None

    J. H. Woo, None

    M. S. Lee, None

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