Vertebral osteomyelitis in patients with an underlying malignancy or chronic kidney disease - who is at higher risk for adverse outcome?

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES Infection Pub Date : 2024-12-21 DOI:10.1007/s15010-024-02451-2

Dorothee Jochimsen, Ayla Yagdiran, Charlotte Meyer-Schwickerath, Krishnan Sircar, Nikolaus Kernich, Peer Eysel, Carolyn Weber, Norma Jung

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Abstract

Purpose: Patients with vertebral osteomyelitis (VO) and comorbidities, notably chronic kidney disease (CKD), are at risk of early mortality. The aim of this study was to compare characteristics and outcomes of VO patients with an underlying malignancy (ONCO) to VO patients with CKD and VO patients without comorbidities (CONTROL).

Methods: We performed a retrospective analysis of data which was prospectively collected between 2008 and 2020. Primary outcome was treatment failure defined as death and/or recurrence of VO within one year.

Results: 241 VO patients (ONCO = 56; CKD = 47; CONTROL = 138) were analysed. Treatment failure occurred in 26% of ONCO and 45% of CKD patients. Staphylococcus aureus was the most common causative pathogen in the CKD (57%) and CONTROL group (43%). ONCO patients showed a broader distribution of common VO-causing pathogens, with coagulase-negative staphylococci (CoNS) accounting for the highest proportion of causative bacteria (27%). Nevertheless, S.aureus was associated with a significantly higher risk of treatment failure in VO ONCO patients.

Conclusion: Treatment failure in VO CKD patients was twice as high as in VO ONCO patients. However, both groups showed high treatment failure rates. CoNS should be considered when starting empirical antibiotic treatment in VO ONCO patients. Moreover, oncological patients with VO caused by S.aureus should be monitored closely.

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伴有潜在恶性肿瘤或慢性肾脏疾病的椎体骨髓炎患者——谁有更高的不良后果风险？

目的：患有椎体骨髓炎（VO）和合并症的患者，特别是慢性肾脏疾病（CKD），有早期死亡的风险。本研究的目的是比较伴有潜在恶性肿瘤（ONCO）的VO患者、伴有CKD的VO患者和无合并症（CONTROL）的VO患者的特征和结果。方法：我们对2008年至2020年期间前瞻性收集的数据进行回顾性分析。主要终点是治疗失败，定义为一年内死亡和/或VO复发。结果：VO患者241例(ONCO = 56；ckd = 47；对照= 138例)。26%的ONCO和45%的CKD患者出现治疗失败。金黄色葡萄球菌是CKD中最常见的致病菌（57%）和对照组（43%）。ONCO患者常见致病菌分布较广，其中凝固酶阴性葡萄球菌（con）致病菌占比最高（27%）。然而，金黄色葡萄球菌与VO ONCO患者治疗失败的风险显著升高相关。结论：VO CKD患者的治疗失败率是VO ONCO患者的两倍。然而，两组的治疗失败率都很高。在VO ONCO患者开始经验性抗生素治疗时应考虑CoNS。此外，应密切监测由金黄色葡萄球菌引起的肿瘤VO患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.