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Benavent E, Kortajarena X, Sobrino-Diaz B, Gasch O, Rodríguez-Pardo D, Escudero-Sanchez R, Bahamonde A, Rodriguez-Montserrat D, García-País MJ, Del Toro López MD, Sorli L, Nodar A, Vilchez HH, Muñez E, Iribarren JA, Ariza J, Murillo O. Vertebral osteomyelitis after spine instrumentation surgery: risk factors and management. J Hosp Infect 2023; 140:102-109. [PMID: 37482096 DOI: 10.1016/j.jhin.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Vertebral osteomyelitis after spine instrumentation surgery (pVOM) is a rare complication. Most cases of infection occur early after surgery that involve skin and soft tissue and can be managed with debridement, antibiotics, and implant retention (DAIR). AIM To identify pVOM risk factors and evaluate management strategies. METHODS From a multicentre cohort of deep infection after spine instrumentation (IASI) cases (2010-2016), pVOM cases were compared with those without vertebral involvement. Early and late infections were defined (<60 days and >60 days after surgery, respectively). Multivariate analysis was used to explore risk factors. FINDINGS Among 410 IASI cases, 19 (4.6%) presented with pVOM, ranging from 2% (7/347) in early to 19.1% (12/63) in late IASIs. After multivariate analysis, age (adjusted odds ratio (aOR): 1.10; 95% confidence interval (CI): 1.03-1.18), interbody fusion (aOR: 6.96; 95% CI: 2-24.18) and coagulase-negative staphylococci (CoNS) infection (aOR: 3.83; 95% CI: 1.01-14.53) remained independent risk factors for pVOM. Cases with pVOM had worse prognoses than those without (failure rate; 26.3% vs 10.8%; P = 0.038). Material removal was the preferred strategy (57.9%), mainly in early cases, without better outcomes (failure rate; 33.3% vs 50% compared with DAIR). Late cases managed with removal had greater success compared with DAIR (failure rate; 0% vs 40%; P = 0.067). CONCLUSION Risk factors for pVOM are old age, use of interbody fusion devices and CoNS aetiology. Although the diagnosis leads to a worse prognosis, material withdrawn should be reserved for late cases or when spinal fusion is achieved.
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Affiliation(s)
- E Benavent
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - X Kortajarena
- Infectious Diseases Department, Hospital Universitario Donostia, Gipuzkoa, Spain
| | - B Sobrino-Diaz
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Department of Infectious Diseases, Hospital Regional Universitario Málaga - Instituto de investigacion biomedica de Málaga (IBIMA), Málaga, Spain
| | - O Gasch
- Infectious Diseases Department, Hospital Parc Tauli de Sabadell, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - D Rodríguez-Pardo
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - R Escudero-Sanchez
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Infectious Disease Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - A Bahamonde
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Department of Internal Medicine-Infectious Diseases, Hospital Universitario del Bierzo, León, Spain
| | - D Rodriguez-Montserrat
- Orthopedic Surgery Department, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - M J García-País
- Infectious Disease Unit and Microbiology Departments, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - M D Del Toro López
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases and Microbiology, University Hospital Virgen Macarena, Seville, Spain; Biomedicine Institute of Sevilla/Department of Medicine, University of Seville/CSIC, Seville, Spain
| | - L Sorli
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Infectious Diseases Department, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - A Nodar
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Infectious Diseases Unit, Internal Medicine Department and Instituto de Investigación Biomédica Galicia Sur, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - H H Vilchez
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases, Fundació Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - E Muñez
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Infectious Diseases Unit, Internal Medicine Department, Universitary Hospital Puerta de Hierro-Majadahonda - Research Institute Puerta de Hierro-Segovia de Arana (IDPHISA), Madrid, Spain
| | - J A Iribarren
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Infectious Diseases Department, Hospital Universitario Donostia, Gipuzkoa, Spain; Biodonostia Health Research Institute, Gipuzkoa, Spain
| | - J Ariza
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - O Murillo
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
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Muñoz P, de la Villa P, Ramallo V, Mestres C, Goenaga M, Kortajarena X, Hidalgo-Tenorio C, de Jesús S, Fariñas M, Antorrena I, Rodríguez-Esteban M, Castelo L, García-Vázquez E, Ramos A, Bouza E. Análisis de una cohorte de pacientes con endocarditis infecciosa tratados con linezolid. Cirugía Cardiovascular 2018. [DOI: 10.1016/j.circv.2017.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kortajarena X, Goenaga MA, Ibarguren M, Azkune H, Bustinduy MJ, Fuertes A, Ibarguren O, Goyeneche M, Garcia M. Outpatient parenteral antimicrobial therapy for infective endocarditis in patients over 80 years. Rev Esp Quimioter 2017; 30:276-279. [PMID: 28585797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The incidence of infective endocarditis is progressively increasing, especially in elderly patients. Outpatient parenteral antibiotic therapy (OPAT) is being an excellent alternative for treatment, but advanced age is one of the relative contraindications. The aim of this study is to compare the characteristics and prognosis of patients less or more than 80 years, treated with OPAT. METHODS One hundred and ninety four patients were included between 1996 and 2015, 31 of them older than 80 years. RESULTS The most frequently affected valve is the aortic one, mainly native valves. Most used antibiotics are ceftriaxone, ampicillin, cloxacillin and daptomycin. Differences in surgery (39.9% vs 9.7%, p=0.001) and use of infusion pump (55.2% vs 35.5%; p= 0.044) were observed, under 80 years and older respectively. No differences in readmissions and mortality were observed. CONCLUSIONS OPAT could be considered an effective alternative for appropriately-selected elderly patients with infective endocarditis.
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Affiliation(s)
- X Kortajarena
- Xabier Kortajarena, Infectious Disease Unit, Hospital Universitario Donostia, Paseo Doctor Beguiristain s/n. San Sebastian, Spain.
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