Multidisciplinary Treatment for Vertebral Osteomyelitis at our Hospital: An 11-Year Review of 117 Cases

• Published in: Journal of Spine Research Vol. 12; no. 1.2; pp. 4 - 9
• Main Authors: Mori, Gen, Osawa, Toru, Takeura, Nobuaki, Idei, Chihiro, Sukenari, Tsuyoshi, Oishi, Hisao, Matoba, Hiroe, Yoshihara, Yasushi, Kuribayashi, Masaaki, Inoue, Atsuo, Okumura, Hisashi, Ueda, Hideki, Ikeda, Takumi
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society for Spine Surgery and Related Research 20.01.2021
• Subjects: Methicillin-Resistant Staphylococcus aureus; multidisciplinary treatment; vertebral osteomyelitis
• ISSN: 1884-7137; 2435-1563
• DOI: 10.34371/jspineres.2020-0007

Introduction: The incidence of vertebral osteomyelitis has been increasing with the aging society in Japan. The treatment of vertebral osteomyelitis is often difficult because the number of compromised hosts is increasing. We have been providing multidisciplinary treatment for vertebral osteomyelitis since 2007 by cooperating with other departments. We consult with the infection control department for identification of the causative organism and selection of antimicrobial agents and ask the radiology department for computed tomography-guided biopsy and drainage. In this study, we investigated the clinical background, treatment course, and trends of this disease.Methods: For 11 years, from April 2007 to August 2018, we treated 117 patients with pyogenic spondylitis who had been hospitalized in our department. Treatment methods and antimicrobials used were investigated, and their effects on the number of treatment days were examined.Results: The average number of treatment days was 60 days. The treatment period did not correlate with the hospitalization history, affected vertebrae, and Kulowski classification. The compromised host rate was 59%, and the treatment period was significantly prolonged. The detection rate of the causative organism was 63%. There were 52 gram-positive cocci, of which 29% were methicillin-resistant Staphylococcus aureus (MRSA). The treatment period of MRSA was significantly longer than that of the top three causative organisms (methicillin-susceptible S. aureus, streptococcus, and Escherichia coli). The treatment period was shorter in the group using the first-generation cephem system, and the treatment period was longer in the group using anti-MRSA drugs. Even though the causative organism was unknown, it did not affect the treatment period. Of the 12 patients whose treatment period was prolonged for > 100 days, all were compromised hosts, and 92% of the causative organisms were MRSA.Conclusions: In the treatment of vertebral osteomyelitis, the importance of collaboration with other departments, intervention of the infection control department, proper use of antibacterial drugs, and early treatment has been reported. We believe that appropriate and prompt treatment was possible using a multidisciplinary approach at our hospital. In this study, the treatment period was not affected even in the group with unknown causative bacteria, suggesting that the causative bacteria were similar to the bacteria-detecting group. These results suggest that the use of first-generation cephem antibiotics as a first-line drug for patients with unknown causative organisms is appropriate. However, there is a need for improvement in MRSA cases, such as selection of antibiotics and early response to minimally invasive surgery.