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- Title
Native vertebral osteomyelitis in aged patients: distinctive features. An observational cohort study.
- Authors
Aguilar-Company, Juan; Pigrau, Carles; Fernández-Hidalgo, Nuria; Rodríguez-Pardo, Dolors; Falcó, Vicenç; Lung, Mayli; Pellisé, Ferran; Almirante, Benito
- Abstract
Purpose: To describe the demographic, clinical, and microbiological profile of native vertebral osteomyelitis (NVO) in aged patients as compared to that of younger patients, to identify differences that could motivate changes in clinical management.Methods: Retrospective, observational cohort study (1990-2015) including all adult patients with microbiologically confirmed NVO divided into 2 groups: aged (≥ 65 years) vs younger (18-64 years).Results: 247 patients included, 138 aged and 109 younger. Relative to younger patients, the aged had higher rates of healthcare-related infection (40.6 vs 25.7%, p = 0.014), previous known heart valve disease (29.7 vs 9.2%, p < 0.001), and concomitant infective endocarditis (38.4 vs 20.2%, p = 0.002). The groups showed similar rates of symptomatic spinal cord compression (14.5 vs 11.9%, p = 0.556) and paraspinal abscesses (62.3 vs 68.8%, p = 0.288) at presentation. There was a trend to lower spine surgery rates in the aged (11.6 vs 17.4%, p = 0.192). On univariate analysis, Staphylococcus aureus infection was associated with higher in-hospital mortality in aged (29%, OR 4.3, 95% CI 1.61-11.45). In-hospital mortality was higher among the aged (14.5 vs 6.4%, p = 0.044) as well as relapse rate due to treatment failure (3.4 vs 1%, p = 0.377).Conclusions: The findings underscore the importance of preventing healthcare-related infection and maintaining high clinical suspicion of infective endocarditis in aged NVO patients to implement proper management. S. aureus infection had a poorer prognosis in this population. As compared to younger patients, spinal surgery rates were slightly lower and overall prognosis poorer in the aged, despite similar rates of symptomatic spinal cord compression and abscesses at presentation.
- Subjects
OSTEOMYELITIS treatment; CROSS infection prevention; ENDOCARDITIS; CONFIDENCE intervals; HEART valve diseases; LONGITUDINAL method; SCIENTIFIC observation; SPINAL cord diseases; SPINAL cord compression; STAPHYLOCOCCAL diseases; STATISTICS; SURVIVAL; DISEASE relapse; RETROSPECTIVE studies; HOSPITAL mortality; ODDS ratio; OLD age; PROGNOSIS
- Publication
Infection, 2018, Vol 46, Issue 5, p679
- ISSN
0300-8126
- Publication type
Article
- DOI
10.1007/s15010-018-1177-6