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

Autor:	de Graeff JJ; Department of Orthopaedic Surgery, Spine Surgery Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA., Paulino Pereira NR; Department of Orthopaedic Surgery, Spine Surgery Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA., van Wulfften Palthe OD; Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA., Nelson SB; Department of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA., Schwab JH; Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Spine Surgery Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Jazyk:	angličtina
Zdroj:	Spine [Spine (Phila Pa 1976)] 2017 Sep 01; Vol. 42 (17), pp. 1339-1346.
DOI:	10.1097/BRS.0000000000002084
Abstrakt:	Study Design: Retrospective cohort study. Objective: The aim of this study was to identify factors independently associated with antibiotic treatment failure in patients with spinal osteomyelitis. Summary of Background Data: There 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. Methods: All patients who underwent antibiotic treatment for spinal osteomyelitis in one of our institutions between January 1, 2001 and January 1, 2015 were identified. Patients who underwent surgery before the start of the antibiotic treatment were excluded. Results: We 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] 1.03-2.79, P = 0.037), fever (HR 1.61, 95% CI 0.93-2.79, P = 0.088), osteomyelitis at an additional site (HR 5.17, 95% CI 2.63-27.9, P = 0.001), and the presence of an epidural abscess (HR 1.91, 95% 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, 95% CI 1.03-2.79, P = 0.019), osteomyelitis at an additional site (HR 8.26, 95% CI 2.51-27.2, P = 0.001), fever (HR 1.77, 95% CI 1.00-3.12, P = 0.050), and the presence of an epidural abscess (HR 1.82, 95% CI 1.06-3.13, P = 0.030) were independently associated with failure of antibiotic treatment. Conclusion: Antibiotic 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 Evidence: 3.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu