Hematogenous vertebral osteomyelitis associated with intravascular device-associated infections – a retrospective cohort study

• Published in: Diagnostic microbiology and infectious disease Vol. 88; no. 1; pp. 75 - 81
• Main Authors: Renz, Nora, Haupenthal, Judith, Schütz, Michael, Trampuz, Andrej
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2017
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Bacterial Infections - diagnosis; Bacterial Infections - epidemiology; Bacterial Infections - pathology; Bacterial Infections - therapy; Blood - microbiology; Blood Culture; Cardiac implantable electronic devices; Coagulase-negative staphylococci; Debridement; Female; Hematogenous; Humans; Infectious Disease; Internal Medicine; Intravascular catheter; Male; Middle Aged; Prostheses and Implants - adverse effects; Retrospective Studies; Spondylitis - diagnosis; Spondylitis - epidemiology; Spondylitis - pathology; Spondylitis - therapy; Vascular Access Devices - adverse effects; Vertebral osteomyelitis; Young Adult; computed tomography; NYHA; magnetic resonance imaging; MRI; ICD; LVAD; coagulase-negative staphylococci; CT; New York Heart Association; peripherally inserted central catheter; hematogenous; intravascular catheter; cardiac implantable electronic devices; CFU; implantable cardioverter device; vertebral osteomyelitis; colony-forming unit; left ventricular assist device; PICC; Intravascular catheter; Cardiac implantable electronic devices; Vertebral osteomyelitis; Coagulase-negative staphylococci; Hematogenous
• ISSN: 0732-8893; 1879-0070
• DOI: 10.1016/j.diagmicrobio.2017.01.020

Abstract Introduction Aim of the study was to investigate the clinical, microbiological, radiological and treatment characteristics of hematogenous vertebral osteomyelitis originating from infected intravascular devices. Patients and methods Patients with secondary hematogenous vertebral osteomyelitis caused by an infected intravascular device were included in this retrospective cohort study. Patients with prior spinal surgery were excluded. Categorical variables were compared using χ2 or Fisher's exact tests and continuous variables using the Mann–Whitney U test. Results Sixty-seven patients with hematogenous vertebral osteomyelitis were included. Intravenous catheters were the source of infection in 45 patients (67%) and cardiovascular devices in 22 (33%). Fever was present in 21 patients (45%). The main pathogens were coagulase-negative staphylococci, isolated in 42 patients (63%), which grew from blood culture in 52 patients (87%), from vertebral tissue in 29 patients (56%) and from the explanted intravascular device in 18 patients (60%), where it was sampled. Infective endocarditis was diagnosed in 14 of 45 patients (31%), more common with cardiovascular devices than with intravascular catheters (56% versus 15%; p = 0.008). Conclusions In patients with vertebral osteomyelitis, growth of coagulase-negative staphylococci in blood is highly suggestive for intravascular device-associated infection. Despite absence of systemic or local signs of inflammation at the site of the device, blood cultures should be collected and echocardiography performed in these patients.