A retrospective cohort study of bacterial native vertebral osteomyelitis and its management in the UK
Background: Bacterial native vertebral osteomyelitis (NVO) can present diagnostic and therapeutic challenges leading to high levels of morbidity and mortality. To inform strategies aimed at improving outcomes in these patients, data are needed on the current aetiology, diagnostic interventions, mana...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-11-01
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| Series: | Clinical Infection in Practice |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590170221000388 |
| _version_ | 1818403899967537152 |
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| author | Rachel Bousfield Isobel Ramsay Ben Warne Deevia Kotecha Tamara Mitchell Jonathan Sandoe Elinor Moore Emma Nickerson Andrew Kirby David Enoch |
| author_facet | Rachel Bousfield Isobel Ramsay Ben Warne Deevia Kotecha Tamara Mitchell Jonathan Sandoe Elinor Moore Emma Nickerson Andrew Kirby David Enoch |
| author_sort | Rachel Bousfield |
| collection | DOAJ |
| description | Background: Bacterial native vertebral osteomyelitis (NVO) can present diagnostic and therapeutic challenges leading to high levels of morbidity and mortality. To inform strategies aimed at improving outcomes in these patients, data are needed on the current aetiology, diagnostic interventions, management and risk factors for treatment failure. Methods: This was a retrospective, multicentre, observational cohort study of adult patients with bacterial NVO across the UK between 1st January 2015 and 31st December 2016. Infectious Disease Society of America (IDSA) guideline standards were selected and used to audit practice relating to the management of these patients. Results: A total of 286 patients were included from 40 hospitals. An organism was identified in 61% of cases by blood culture or biopsy. Of these, 51% were due to Staphylococcus aureus and 12% were due to Gram-negative bacteria. When performed, biopsy obtained a microbiological diagnosis in 50% of cases. Nearly 10% of patients required admission to an Intensive Care Unit, 20% were re-admitted to hospital, 56% experienced complications and 6% died within 90 days. Higher Charlson comorbidity index (CCI) was significantly associated with treatment failure at one month (p = 0.004). Conclusions: This study identified opportunities to improve UK practice in the investigation and management of bacterial NVO. The range of organisms isolated supports the use of diagnostic biopsy where blood cultures are non-diagnostic, to guide antimicrobial therapy and strive to avoid treatment failure or complications. This study shows a clear need for antibiotic guidelines to reflect the current aetiology of NVO and authors support the creation of a formal registry. |
| first_indexed | 2024-12-14T08:31:36Z |
| format | Article |
| id | doaj.art-76db9fa90d3b4806a6d0bb218aa6326f |
| institution | Directory Open Access Journal |
| issn | 2590-1702 |
| language | English |
| last_indexed | 2024-12-14T08:31:36Z |
| publishDate | 2021-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical Infection in Practice |
| spelling | doaj.art-76db9fa90d3b4806a6d0bb218aa6326f2022-12-21T23:09:31ZengElsevierClinical Infection in Practice2590-17022021-11-0112100101A retrospective cohort study of bacterial native vertebral osteomyelitis and its management in the UKRachel Bousfield0Isobel Ramsay1Ben Warne2Deevia Kotecha3Tamara Mitchell4Jonathan Sandoe5Elinor Moore6Emma Nickerson7Andrew Kirby8David Enoch9Cambridge University Hospitals NHS Foundation Trust, United Kingdom; Corresponding author at: Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom.Cambridge University Hospitals NHS Foundation Trust, United KingdomCambridge University Hospitals NHS Foundation Trust, United KingdomUniversity of Leicester, United KingdomSheffield Teaching Hospitals NHS Foundation Trust, United KingdomUniversity of Leeds, United KingdomCambridge University Hospitals NHS Foundation Trust, United KingdomCambridge University Hospitals NHS Foundation Trust, United KingdomCambridge University Hospitals NHS Foundation Trust, United KingdomPublic Health England, United KingdomBackground: Bacterial native vertebral osteomyelitis (NVO) can present diagnostic and therapeutic challenges leading to high levels of morbidity and mortality. To inform strategies aimed at improving outcomes in these patients, data are needed on the current aetiology, diagnostic interventions, management and risk factors for treatment failure. Methods: This was a retrospective, multicentre, observational cohort study of adult patients with bacterial NVO across the UK between 1st January 2015 and 31st December 2016. Infectious Disease Society of America (IDSA) guideline standards were selected and used to audit practice relating to the management of these patients. Results: A total of 286 patients were included from 40 hospitals. An organism was identified in 61% of cases by blood culture or biopsy. Of these, 51% were due to Staphylococcus aureus and 12% were due to Gram-negative bacteria. When performed, biopsy obtained a microbiological diagnosis in 50% of cases. Nearly 10% of patients required admission to an Intensive Care Unit, 20% were re-admitted to hospital, 56% experienced complications and 6% died within 90 days. Higher Charlson comorbidity index (CCI) was significantly associated with treatment failure at one month (p = 0.004). Conclusions: This study identified opportunities to improve UK practice in the investigation and management of bacterial NVO. The range of organisms isolated supports the use of diagnostic biopsy where blood cultures are non-diagnostic, to guide antimicrobial therapy and strive to avoid treatment failure or complications. This study shows a clear need for antibiotic guidelines to reflect the current aetiology of NVO and authors support the creation of a formal registry.http://www.sciencedirect.com/science/article/pii/S2590170221000388DiscitisOsteomyelitis |
| spellingShingle | Rachel Bousfield Isobel Ramsay Ben Warne Deevia Kotecha Tamara Mitchell Jonathan Sandoe Elinor Moore Emma Nickerson Andrew Kirby David Enoch A retrospective cohort study of bacterial native vertebral osteomyelitis and its management in the UK Clinical Infection in Practice Discitis Osteomyelitis |
| title | A retrospective cohort study of bacterial native vertebral osteomyelitis and its management in the UK |
| title_full | A retrospective cohort study of bacterial native vertebral osteomyelitis and its management in the UK |
| title_fullStr | A retrospective cohort study of bacterial native vertebral osteomyelitis and its management in the UK |
| title_full_unstemmed | A retrospective cohort study of bacterial native vertebral osteomyelitis and its management in the UK |
| title_short | A retrospective cohort study of bacterial native vertebral osteomyelitis and its management in the UK |
| title_sort | retrospective cohort study of bacterial native vertebral osteomyelitis and its management in the uk |
| topic | Discitis Osteomyelitis |
| url | http://www.sciencedirect.com/science/article/pii/S2590170221000388 |
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