Universität zu Köln

Jung, N., Ernst, A., Joost, I, Yagdiran, A., Peyerl-Hoffmann, G., Grau, S., Breuninger, M., Hellmich, M., Kubosch, D. C., Klingler, J. H., Seifert, H., Kern, W., V, Kaasch, A. J. and Rieg, S. (2021). Vertebral osteomyelitis in patients with Staphylococcus aureus bloodstream infection: Evaluation of risk factors for treatment failure. J. Infect., 83 (3). S. 314 - 321. LONDON: W B SAUNDERS CO LTD. ISSN 1532-2742

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Abstract

Objectives: Staphylococcus aureus is the most common cause of pyogenic vertebral osteomyelitis (VO). Studies indicate that S. aureus VO results in poor outcome. We aimed to investigate risk factors for treatment failure in patients with Staphylococcus aureus bloodstream infection (SAB) and VO. Methods: We conducted a post hoc-analysis of data from a German bi-center prospective SAB cohort (2006-2014). Patients were followed-up for one year. Primary outcome was treatment failure defined as relapse and/or death within one year. Results: A total of 1069 patients with SAB were analyzed, with 92 VO patients. In addition to antibiotic treatment, surgery was performed in 60/92 patients. Treatment failed in 44/92 patients (death, n = 42; relapse, n = 2). Multivariable analysis revealed higher age (HR 1.04 [per year], 95%CI 1.01-1.07), Charlson comorbidity index (HR 1.20, 95%CI 1.06-1.36), presence of neurologic deficits (HR 2.53, 95%CI 1.15-5.53) and local abscess formation (HR 3.35, 95%CI 1.39-8.04) as independent risk factors for treatment failure. In contrast, surgery seemed to be associated with a favourable outcome (HR 0.45 (95%CI 0.20-0.997)). Conclusion: SAB patients with VO exhibit a high treatment failure rate. Red flags are older age, comorbidities, neurologic deficits and local abscess formation. Whether these patients benefit from intensified treatment (e.g. radical surgery, prolongation of antibiotics) should be investigated further. (C) 2021 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Jung, N. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ernst, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Joost, I UNSPECIFIED UNSPECIFIED UNSPECIFIED Yagdiran, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Peyerl-Hoffmann, G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Grau, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Breuninger, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hellmich, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kubosch, D. C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Klingler, J. H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Seifert, H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kern, W., V UNSPECIFIED UNSPECIFIED UNSPECIFIED Kaasch, A. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rieg, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-594483
DOI:	10.1016/j.jinf.2021.06.010
Journal or Publication Title:	J. Infect.
Volume:	83
Number:	3
Page Range:	S. 314 - 321
Date:	2021
Publisher:	W B SAUNDERS CO LTD
Place of Publication:	LONDON
ISSN:	1532-2742
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LONG-TERM MORTALITY; PYOGENIC SPONDYLODISCITIS; SURGICAL-TREATMENT; OUTCOMES Multiple languages Infectious Diseases Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/59448