Program Schedule

698
Optimal Duration of Antibiotic Therapy in Patients with Hematogenous Vertebral Osteomyelitis Who Undergo and Do Not Undergo Surgical Debridement

Session: Poster Abstract Session: Approach to Clinical Infections
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • 2014 IDweek_Optimal duration.pdf (2.4 MB)
  • Background: Surgery is frequently performed in patients with hematogenous vertebral osteomyelitis (HVO) for resolution of significant spinal cord compression, prevention or correction of spinal instability, management of severe pain, and drainage of abscesses. The aim of the study is to evaluate the optimal duration of antibiotic therapy in patients with HVO who undergo and do not undergo surgical debridement.

    Methods: We conducted a retrospective chart review of adult patients (≥16 years of age) with HVO from five tertiary care hospitals over a 7-year period. HVO was defined as both radiographic evidence of vertebral osteomyelitis and microbiologic demonstration of bacterial pathogens either from the site of infection itself (e.g., abscess, intervertebral disc, or vertebral bone) or the blood.

    Results: Of the 333 patients with microbiologically diagnosed HVO, 143 (41.9%) underwent surgery and 190 (58.1%) did not undergo surgery. Compared with no surgery group, surgery group was more likely to have neurologic deficit (22.4% [32/143] vs. 11.6% [22/190]; P = 0.008) and epidural involvement (66.9% [95/142] vs. 42.9% [79/188]; P <0.001). Of the 333 study patients, 28 died before completing antimicrobial therapy for their infection (8 [5.6%] in the surgery group and 20 [10.5%] in no surgery group; P =0.11). Of remaining 305 patients, 27 (8.9%) experienced recurrence within 12-month post-treatment follow-up. Among no surgery group, recurrence was more common in patients treated with <8 weeks of antibiotic therapy than in those treated with >8 weeks of therapy (23.7% [14/59] vs. 6.3% [7/111]; P = 0.001). However, this association was not evident among surgery group (9.1% [4/44] vs. 2.2% [2/91]; P = 0.09). Multivariate analysis indicated that end stage renal disease (OR, 6.28; 95% CI, 1.46–26.91), <8 weeks of antibiotic treatment (OR, 4.85; 95% CI, 2.01–11.70), no surgical debridement (OR, 2.72; 95% CI, 1.02–7.29), and MRSA (OR, 2.38; 95% CI, 1.01–5.65) were independently associated with recurrence.

    Conclusion: Prolonged antibiotic therapy of >8 weeks was beneficial in patients who did not undergo surgical debridement, but this association was not evident in patients who underwent surgical debridement.

    Ki-Ho Park, MD1, Oh-Hyun Cho, MD2, In-Gyu Bae, MD2, Yu-Mi Lee, MD3, Chisook Moon, MD3, Seong Yeon Park, MD4, Sung-Han Kim, MD5, Sang-Oh Lee, MD5, Sang-Ho Choi, MD5, Jun Hee Woo, MD5, Yang Soo Kim, MD5 and Mi Suk Lee, MD1, (1)Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, South Korea, (2)Division of Infectious Diseases, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea, (3)Department of Infectious Diseases, Busan Paik Hospital, Busan, South Korea, (4)Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea, (5)Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Disclosures:

    K. H. Park, None

    O. H. Cho, None

    I. G. Bae, None

    Y. M. Lee, None

    C. Moon, None

    S. Y. Park, None

    S. H. Kim, None

    S. O. Lee, None

    S. H. Choi, None

    J. H. Woo, None

    Y. S. Kim, None

    M. S. Lee, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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