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lüll Hematogenous vertebral osteomyelitis due to Staphylococcus aureus in the adult: clinical features and therapeutic outcomes Priest DH; Peacock JE JrSouth Med J 2005[Sep]; 98 (9): 854-62OBJECTIVE: Staphylococcus aureus is the most common cause of hematogenous vertebral osteomyelitis in adults. To better define clinical features and therapeutic outcomes, the charts of 40 adult patients with S aureus hematogenous vertebral osteomyelitis were retrospectively reviewed. METHODS: Retrospective chart review using standardized data collection form. RESULTS: S aureus hematogenous vertebral osteomyelitis commonly occurred in the settings of recent invasive procedures (55% of patients), insulin use (28%), and hemodialysis (20%). Ten percent of patients had S aureus bacteremia or vascular catheter infection within the preceding 6 months. Median time from first symptom to diagnosis was 51.3 days. A portal of entry for S aureus was identified in 13 patients (32.5%); intravenous catheters were the likely origin in 9 of those 13 patients. Concurrent endocarditis was present in 4 patients. Forty-eight percent of patients had neurologic abnormalities and 60% of patients had an epidural, paraspinous, or psoas abscess demonstrated by neuroimaging. S aureus was isolated through fine-needle aspiration in 17 of 23 patients (74%) and from blood cultures in 23 of 34 patients (68%). Infection was due to methicillin-susceptible S aureus in 67.5% of patients. All patients received intravenous antibiotics for a mean duration of 58.6 days; 36 of 40 (90%) also received concomitant rifampin. Twenty-seven percent and 12.5% of patients underwent surgical debridement and CT-guided drainage of abscesses, respectively. After intravenous therapy, 19 of 30 eligible patients received oral continuation treatment. The mean duration of total antibiotic therapy was 142.2 days. CONCLUSIONS: Cure of infection was achieved in 83% (24/29) of evaluable patients, but 50% of those achieving cure still had infection-related sequelae. Intravenous antibiotic therapy for at least 8 weeks was the only clinical factor associated with cure (P = 0.05, two-tailed Fisher exact test).|*Staphylococcus aureus[MESH]|Abscess/microbiology[MESH]|Administration, Oral[MESH]|Aged[MESH]|Anti-Bacterial Agents/therapeutic use[MESH]|Bacteremia/microbiology[MESH]|Blood Sedimentation[MESH]|Debridement[MESH]|Diabetes Mellitus, Type 1/complications[MESH]|Drainage[MESH]|Drug Therapy, Combination[MESH]|Female[MESH]|Humans[MESH]|Infusions, Parenteral[MESH]|Kidney Failure, Chronic/complications/therapy[MESH]|Leukocytosis/diagnosis[MESH]|Male[MESH]|Methicillin Resistance[MESH]|Middle Aged[MESH]|Osteomyelitis/diagnosis/*microbiology/mortality/therapy[MESH]|Renal Dialysis[MESH]|Retrospective Studies[MESH]|Spinal Diseases/diagnosis/*microbiology/mortality/therapy[MESH]|Staphylococcal Infections/*diagnosis/mortality/*therapy[MESH] |