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Spontaneous vertebral osteomyelitis: comparison of cases without a microbiological diagnosis to definite pyogenic and tuberculous cases

Abstract number: P1622

Luzzati R., Giacomazzi D., Danzi M., Solbiati M., Tedesco A., Concia E.

Objectives: Vertebral osteomyelitis is an uncommon but serious entity, whose aetiologic diagnosis is not always possible. Few data are available on outcome of cases without a microbiological diagnosis (possible vertebral osteomyelitis). The aim of this study was to analyse features, diagnostic approach, management, and outcome of spontaneous vertebral osteomyelitis cases in adults.

Methods: We performed a retrospective review of 82 cases of vertebral osteomyelitis presenting over a 11-year period (from 1995 to 2005) to 2 Italian tertiary hospitals. All patients had a strict case definition. We compared data in patients with vertebral osteomyelitis due to various aetiologies and possible vertebral osteomyelitis.

Results: A total of 82 patients met diagnostic criteria for vertebral osteomyelitis, giving an incidence of 0.83/100,000 inhabitants/year. The diagnostic yields of blood culture, CT-guided percutaneous needle biopsy of spine, and surgical culture were 43.6%, 72.7%, and 91.6%, respectively. Finally, a causative organism was identified in 60 (73.2%) of 82 cases. Mycobacterium tuberculosis was the organism most frequently responsible for the illness, followed by Staphylococcus aureus, streptococci, and Gram-negative bacilli. The median diagnostic delay was longer in tuberculous cases (4 months) than in pyogenic (1 month) and possible vertebral osteomyelitis cases (0.5 month) (P < 0.017). All patients received antibiotic treatment, and 21 (25.5%) of them underwent additional surgical treatment. This was required more frequently in tuberculous cases (40.7%) than in pyogenic (25.0%) and possible cases (9.1%) (P < 0.028). Recovery was more frequent in pyogenic (78.1%) and possible cases (81.8%) than in tuberculous cases (30.8%) (P = 0.26). Of 67 patients who completed the 1-year follow-up period, 2 relapsed, 3 died and 24 had persisting painful disability. The latter finding was more frequent in tuberculous cases (66.7%) than in pyogenic (21.7%) and possible cases (15.0%) (P < 0.03).

Conclusion: Nearly a fourth of spontaneous vertebral osteomyelitis cases does not achieve a microbiological diagnosis even after undergoing invasive diagnostic methods. However, possible vertebral osteomyelitis cases treated at our institutions have both diagnostic delay and outcome similar to that shown by pyogenic cases. The challenge continues to be the earlier recognition of tuberculous vertebral osteomyelitis that is associated to the highest risk of long-term morbidity.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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