• Spine · Jan 2017

    Prognostic Factors for Failure of Antibiotic Treatment in Patients With Osteomyelitis of the Spine.

    • Jan Jaap de Graeff, Nuno Rui Paulino Pereira, Olivier D van Wulfften Palthe, Sandra B Nelson, and Joseph H Schwab.
    • *Department of Orthopaedic Surgery, Spine Surgery Service, Massachusetts General Hospital - Harvard Medical School †Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital - Harvard Medical School ‡Department of Infectious Diseases, Massachusetts General Hospital - Harvard Medical School §Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Spine Surgery Service, Massachusetts General Hospital - Harvard Medical School.
    • Spine. 2017 Jan 27.

    Study DesignRetrospective cohort study.ObjectiveIdentify factors independently associated with antibiotic treatment failure in patients with spinal osteomyelitis.Summary Of Background DataThere are few studies that have identified risk factors for antibiotic treatment failure in medically-managed spinal osteomyelitis. Identifying such factors could help to identify patients who can be treated solely with antibiotics.MethodsAll patients who underwent antibiotic treatment for spinal osteomyelitis in one of our institutions between January 1 2001 until January 1 2015 were identified. Patients who underwent surgery before the start of the antibiotic treatment were excluded.ResultsWe included 215 patients with a mean age of 58 years; 63 (29%) patients had failure of antibiotic treatment. Diabetes (Hazard Ratio [HR] 1.69, 95% Confidence Interval [CI] 1.03 to 2.79, p = 0.037), fever (HR 1.61, CI 0.93 to 2.79, p = 0.088), osteomyelitis at an additional site (HR 5.17, CI 2.63 to 27.9, p = 0.001), and the presence of an epidural abscess (HR 1.91, CI 1.05-3.45, p = 0.033) were associated with failure of antibiotic treatment. In the multivariate Cox regression analysis, diabetes (HR 1.69, CI 1.03-2.79, p = 0.019), osteomyelitis at an additional site (HR 8.26, CI 2.51-27.2, p = 0.001), fever (HR 1.77, CI 1.00-3.12, p 0.050) and the presence of an epidural abscess (HR 1.82, CI 1.06-3.13, p = 0.030) were independently associated with failure of antibiotic treatment.ConclusionsAntibiotic treatment failed in 29% of patients; diabetes, current other osteomyelitis and having an epidural abscess were independently associated with failure of antibiotic treatment.Level Of Evidence3.

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