Optimal duration of antibiotic therapy in patients with hematogenous vertebral osteomyelitis at low risk and high risk of recurrence

Ki Ho Park, Oh Hyun Cho, Jung Hee Lee, Ji Seon Park, Kyung Nam Ryu, Seong Yeon Park, Yu Mi Lee, Yong Pil Chong, Sung Han Kim, Sang Oh Lee, Sang Ho Choi, In Gyu Bae, Yang Soo Kim, Jun Hee Woo, Mi Suk Lee

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115 Scopus citations

Abstract

Background. The optimal duration of antibiotic treatment for hematogenous vertebral osteomyelitis (HVO) should be based on the patient's risk of recurrence, but it is not well established. Methods. A retrospective review was conducted to evaluate the optimal duration of antibiotic treatment in patients with HVO at low and high risk of recurrence. Patients with at least 1 independent baseline risk factor for recurrence, determined by multivariable analysis, were considered as high risk and those with no risk factor as low risk. Results. A total of 314 patients with microbiologically diagnosed HVO were evaluable for recurrence. In multivariable analysis, methicillin-resistant Staphylococcus aureus infection (adjusted odds ratio [aOR], 2.61; 95% confidence interval [CI], 1.16-5.87), undrained paravertebral/psoas abscesses (aOR, 4.09; 95% CI, 1.82-9.19), and end-stage renal disease (aOR, 6.58; 95% CI, 1.63-26.54) were independent baseline risk factors for recurrence. Therefore, 191 (60.8%) patients were classified as low risk and 123 (39.2%) as high risk. Among high-risk patients, there was a significant decreasing trend for recurrence according to total duration of antibiotic therapy: 34.8% (4-6 weeks [28-41 days]), 29.6% (6-8 weeks [42-55 days]), and 9.6% (≥8 weeks [≥56 days]) (P =. 002). For low-risk patients, this association was still significant but the recurrence rates were much lower: 12.0% (4-6 weeks), 6.3% (6-8 weeks), and 2.2% (≥8 weeks) (P =. 02). Conclusions. Antibiotic therapy of prolonged duration (≥8 weeks) should be given to patients with HVO at high risk of recurrence. For low-risk patients, a shorter duration (6-8 weeks) of pathogen-directed antibiotic therapy may be sufficient.

Original languageEnglish
Pages (from-to)1262-1269
Number of pages8
JournalClinical Infectious Diseases
Volume62
Issue number10
DOIs
StatePublished - 15 May 2016

Keywords

  • antibiotic
  • outcome
  • spondylitis
  • treatment
  • vertebral osteomyelitis

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