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- Title
Optimal Duration of Antibiotic Therapy in Patients With Hematogenous Vertebral Osteomyelitis at Low Risk and High Risk of Recurrence.
- Authors
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
- 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 withmicrobiologically 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 highrisk 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.
- Subjects
OSTEOMYELITIS treatment; ANTIBIOTICS; DISEASE relapse; PHYSIOLOGICAL effects of antibiotics; METHICILLIN-resistant staphylococcus aureus
- Publication
Clinical Infectious Diseases, 2016, Vol 62, Issue 10, p1262
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciw098