Methods: We conducted a retrospective case series study of adults diagnosed with VO from 1 August 2010 to 31 August 2015 at Palmetto Health Hospitals in Columbia, SC. Cases identified by ICD-9 codes were included in the analysis if they met clinical, imaging and microbiology, criteria.
Results: Analysis is based on 150 cases of VO with a mean age of 61 years, a male predominance (91; 61%), and an average body mass index of 29 kg/m2 . Comorbidities included diabetes mellitus (69; 46%), tobacco use (33; 22%), and hemodialysis (20; 13%). Thirty-seven (25%) cases had recent related injury or vertebral surgery, and 14 (9%) had prior hardware. Bone, disc, or adjacent tissue cultures were obtained in 129 (86%) of cases; 60 (40%) of these had >1 sample taken. The remaining 14% had blood cultures alone. 36 cases (24%) had culture negative VO. In the remaining 114 cases, 132 organisms were isolated. 111 (84%) of organisms were gram-positive cocci (GPC). Of those, the majority were Staphylococcus aureus. (66; 59%) (26/66 were methicillin resistant), coagulase-negative staphylococci (20; 18%) and Streptococcus spp. (17; 15%). Enterobacteriaceae accounted for 13/17 gram-negative bacilli (GNB), with only 1 isolate of Pseudomonas aeruginosa. Of the GNB, 11/17 were susceptible to either ceftriaxone or ciprofloxacin.
Conclusion: There was a predominance of VO due to GPC suggesting that intravenous vancomycin monotherapy may be reasonable for empiric therapy in non-critically ill patients while awaiting Gram stain and clinical culture results. Addition of either ceftriaxone or ciprofloxacin to vancomycin would increase cumulative antimicrobial coverage from 84% to 92%.
S. Weissman, None
M. N. Al-Hasan, None
C. Derrick, None
K. Sanasi-Bhola, None