Wide variability of the definitions used for native vertebral osteomyelitis: walking the path for a unified diagnostic framework with a meta-epidemiological approach.

Autor: Petri F; Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, 55905, MN, USA; Department of Infectious Diseases, ASST Fatebenefratelli Sacco, 'L. Sacco' University Hospital, Milan, 20157, Italy. Electronic address: francescopetri2@gmail.com., Mahmoud OK; Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, 55905, MN, USA., Zein SE; Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, 55905, MN, USA., Alavi SMA; Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, 6135715753, Iran., Passerini M; Department of Infectious Diseases, ASST Fatebenefratelli Sacco, 'L. Sacco' University Hospital, Milan, 20157, Italy; Department of Pathophysiology and Transplantation, University of Milano, Milan, 20122, Italy., Diehn FE; Department of Radiology, Mayo Clinic, Rochester, 55905, MN, USA., Verdoorn JT; Department of Radiology, Mayo Clinic, Rochester, 55905, MN, USA., Tande AJ; Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, 55905, MN, USA., Nassr A; Department of Orthopedic Surgery, Mayo Clinic, Rochester, 55905, MN, USA., Freedman BA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, 55905, MN, USA., Murad MH; Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, 55905, MN, USA; Evidence-based Practice Center, Mayo Clinic, Rochester, 55905, MN, USA., Berbari EF; Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, 55905, MN, USA. Electronic address: berbari.elie@mayo.edu.
Jazyk: angličtina
Zdroj: The spine journal : official journal of the North American Spine Society [Spine J] 2024 Sep 28. Date of Electronic Publication: 2024 Sep 28.
DOI: 10.1016/j.spinee.2024.09.018
Abstrakt: Background Context: Native Vertebral Osteomyelitis (NVO) has seen a rise in incidence, yet clinical outcomes remain poor with high relapse rates and significant long-term sequelae. The 2015 IDSA Clinical Practice Guidelines initiated a surge in scholarly activity on NVO, revealing a patchwork of definitions and numerous synonyms used interchangeably for this syndrome.
Purpose: To systematically summarize these definitions, evaluate their content, distribution over time, and thematic clustering.
Study Design/setting: Meta-epidemiological study with a systematic review of definitions.
Patients Sample: An extensive search of multiple databases was conducted, targeting trials and cohort studies dating from 2005 to present, providing a definition for NVO and its synonyms.
Outcome Measures: Analysis of the diagnostic criteria that composed the definitions and the breaking up of the definitions in the possible combinations of diagnostic criteria.
Methods: We pursued a thematic synthesis of the published definitions with Boolean logic, yielding single or multiple definitions per included study. Using 8 predefined diagnostic criteria, we standardized definitions, focusing on the minimum necessary combinations used. Definition components were visualized using Sankey diagrams.
Results: The literature search identified 8,460 references, leading to 171 studies reporting on 21,963 patients. Of these, 91.2% were retrospective, 7.6% prospective, and 1.2% RCTs. Most definitions originated from authors, with 29.2% referencing sources. We identified 92 unique combinations of diagnostic criteria across the literature. Thirteen main patterns emerged, with the most common being clinical features with imaging, followed by clinical features combined with imaging and microbiology, and lastly, imaging paired with microbiology.
Conclusions: Our findings underscore the need for a collaborative effort to develop standardized diagnostic criteria. We advocate for a future Delphi consensus among experts to establish a unified diagnostic framework for NVO, emphasizing the core components of clinical features and MRI while incorporating microbiological and histopathological insights to improve both patient outcomes and research advancements.
Competing Interests: Declaration of competing interest One or more of the authors declare financial or professional relationships on ICMJE-TSJ disclosure forms.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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