Prognostic Factors for Failure of Antibiotic Treatment in Patients With Osteomyelitis of the Spine
| Autor: | Nuno Rui Paulino Pereira, Joseph H. Schwab, Sandra B Nelson, Jan Jaap de Graeff, Olivier van Wulfften Palthe |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Epidural abscess medicine.drug_class Antibiotics 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Diabetes mellitus Humans Medicine Orthopedics and Sports Medicine Treatment Failure 030212 general & internal medicine Retrospective Studies business.industry Proportional hazards model Osteomyelitis Hazard ratio Retrospective cohort study Middle Aged Prognosis medicine.disease Confidence interval Anti-Bacterial Agents Surgery Spinal Diseases Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Spine. 42:1339-1346 |
| ISSN: | 1528-1159 0362-2436 |
| DOI: | 10.1097/brs.0000000000002084 |
| Popis: | 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: | OpenAIRE |
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