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Risk Factors and Outcomes of Hematogenous Vertebral Osteomyelitis in Patients With Staphylococcus aureus Bacteremia.
Kinamon, Tori; Dagher, Michael; Park, Lawrence; Ruffin, Felicia; Fowler, Vance G; Maskarinec, Stacey A.
Afiliação
  • Kinamon T; School of Medicine, Duke University, Durham, North Carolina, USA.
  • Dagher M; School of Medicine, Duke University, Durham, North Carolina, USA.
  • Park L; Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
  • Ruffin F; Duke Global Health Institute, Duke University, Durham, North Carolina, USA.
  • Fowler VG; Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
  • Maskarinec SA; Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Clin Infect Dis ; 77(9): 1226-1233, 2023 11 11.
Article em En | MEDLINE | ID: mdl-37747828
BACKGROUND: Hematogenous vertebral osteomyelitis (HVOM) is an incompletely understood complication of Staphylococcus aureus bacteremia (SAB). METHODS: Eligible SAB patients with and without HVOM were prospectively enrolled from 1995 through 2019 at Duke University Health System. HVOM was diagnosed either radiographically or microbiologically. Multivariable logistic regression analysis was performed to identify clinical and microbial factors associated with HVOM risk. All bloodstream S. aureus isolates were genotyped using spa typing. RESULTS: Of 3165 cases of SAB, 127 (4.0%) developed HVOM. Patients who experienced HVOM were more likely to have community-acquired SAB (30.7% vs 16.7%, P < .001), have a longer time to diagnosis of SAB (median, 5 days; interquartile range [IQR], 2-10.5 vs median, 2 days; IQR, 0-4; P < .001), and to exhibit persistent bacteremia (48.8% vs 20.6%, P < .001). A significant number of HVOM patients developed infective endocarditis (26% vs 15.2%, P = .002). Overall, 26.2% (n = 33) of SAB patients with HVOM underwent surgical intervention. Methicillin resistance (46.6% vs 41.7%, P = .318) and bacterial genotype were not associated with the development of HVOM. At the 12-month follow-up, 22% of patients with HVOM had died. Of the surviving patients, 20.4% remained on antibiotic therapy, and 29.6% had recurrence of either HVOM or SAB. CONCLUSIONS: Among patients with SAB, HVOM risk was associated with clinical factors and not bacterial genotype. Despite being a rare complication of SAB, patients with HVOM had high all-cause mortality rates and healthcare resource requirements up to 1 year after their HVOM diagnosis. Close clinical monitoring is indicated in this vulnerable population.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Osteomielite / Infecções Estafilocócicas / Bacteriemia Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Osteomielite / Infecções Estafilocócicas / Bacteriemia Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article