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Weber C, Misfeld M, Diab M, Saha S, Elderia A, Marin-Cuartas M, Luehr M, Yagdiran A, Eysel P, Jung N, Hagl C, Doenst T, Borger MA, Kernich N, Wahlers T. Infective endocarditis and spondylodiscitis-impact of sequence of surgical therapy on survival and recurrence rate. Eur J Cardiothorac Surg 2024; 66:ezae246. [PMID: 38964339 DOI: 10.1093/ejcts/ezae246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/09/2024] [Accepted: 07/03/2024] [Indexed: 07/06/2024] Open
Abstract
OBJECTIVES To date, there are no standardized treatment algorithms or recommendations for patients with infective endocarditis (IE) and concomitant spondylodiscitis (SD). Therefore, our aim was to analyse whether the sequence of surgical treatment of IE and SD has an impact on postoperative outcome and to identify risk factors for survival and postoperative recurrence. METHODS Patients with IE underwent surgery in 4 German university hospitals between 1994 and 2022. Univariable and multivariable analyses were performed to identify possible predictors of 30-day/1-year mortality and recurrence of IE and/or SD. RESULTS From the total IE cohort (n = 3991), 150 patients (4.4%) had concomitant SD. Primary surgery for IE was performed in 76.6%, and primary surgery for SD in 23.3%. The median age was 70.0 (64.0-75.6) years and patients were mostly male (79.5%). The most common pathogens detected were enterococci and Staphylococcus aureus followed by streptococci, and coagulase-negative Staphylococci. If SD was operated on first, 30-day mortality was significantly higher than if IE was operated on 1st (25.7% vs 11.4%; P = 0.037) and we observed a tendency for a higher 1-year mortality. If IE was treated 1st, we observed a higher recurrence rate within 1 year (12.2% vs 0%; P = 0.023). Multivariable analysis showed that primary surgery for SD was an independent predictor of 30-day mortality. CONCLUSIONS Primary surgical treatment for SD was an independent risk factor for 30-day mortality. When IE was treated surgically 1st, the recurrence rate of IE and/or SD was higher.
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Affiliation(s)
- Carolyn Weber
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Martin Misfeld
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich Schiller University Jena, Jena, Germany
- Department of Cardiac Surgery, HKZ Klinikum Herfeld-Rotenburg Rotenburg a.d. Fulda, Germany
| | - Shekhar Saha
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ahmed Elderia
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Maximilian Luehr
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Ayla Yagdiran
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Norma Jung
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich Schiller University Jena, Jena, Germany
| | - Michael A Borger
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Nikolaus Kernich
- Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
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Kilinc F, Gessler F, Kessel J, Dubinski D, Won SY, Tanneberger A, Ghanaati S, Prinz V, Czabanka M, Setzer M, Freiman T, Behmanesh B. From the Oral Cavity to the Spine: Prevalence of Oral Cavity Infections in Patients with Pyogenic Spinal Infection. J Clin Med 2024; 13:1040. [PMID: 38398352 PMCID: PMC10889745 DOI: 10.3390/jcm13041040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
Background incidence of pyogenic spinal infections has increased in recent years. In addition to treating the spinal infection, optimal care also includes identifying the source of the pyogenic spinal infection and the presence of other infections. The aim of this study is to elucidate the prevalence of oral cavity infection (OCI) within this patient cohort. Methods As part of a prospective study conducted from 2016 to 2021, the number of patients with dental infections was investigated by means of an orthopantomogram (OPG) and subsequent dental examination. Results The presence of an oral infection was investigated in 55 (47%) of 118 patients by an OPG, 29 (53%) of whom had a corresponding abnormality of the oral cavity. In addition to the spinal infection, patients with an oral cavity infection revealed an increased incidence of endocarditis, sepsis and brain abscess. A spinal epidural abscess, a multilevel affection of the infection, and an elevated CRP value were also found in patients with a co-existing oral cavity infection. Back pain assessed at admission and 3 months after surgery was also more pronounced in patients with an oral cavity infection. Neurological deficits were often present in patients with spinal and oral cavity infection. Conclusions The presence of an oral cavity infection has proven to be one of the important factors in the detection of the source of the pyogenic spinal infection. In addition, a pronounced spinal affection and frequent co-infections were seen in patients with an oral cavity infection.
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Affiliation(s)
- Fatma Kilinc
- Department of Neurosurgery, Goethe University Hospital, 60528 Frankfurt, Germany; (F.K.); (V.P.); (M.C.); (M.S.)
| | - Florian Gessler
- Department of Neurosurgery, University Medicine of Rostock, 18057 Rostock, Germany; (F.G.); (D.D.); (S.-Y.W.); (T.F.)
| | - Johanna Kessel
- Department of Medicine, Infectious Diseases Unit, Goethe University Hospital, 60596 Frankfurt, Germany;
| | - Daniel Dubinski
- Department of Neurosurgery, University Medicine of Rostock, 18057 Rostock, Germany; (F.G.); (D.D.); (S.-Y.W.); (T.F.)
| | - Sae-Yeon Won
- Department of Neurosurgery, University Medicine of Rostock, 18057 Rostock, Germany; (F.G.); (D.D.); (S.-Y.W.); (T.F.)
| | - Anna Tanneberger
- Department of Maxillofacial Surgery, Goethe University Hospital, 60596 Frankfurt, Germany; (A.T.); (S.G.)
| | - Shahram Ghanaati
- Department of Maxillofacial Surgery, Goethe University Hospital, 60596 Frankfurt, Germany; (A.T.); (S.G.)
| | - Vincent Prinz
- Department of Neurosurgery, Goethe University Hospital, 60528 Frankfurt, Germany; (F.K.); (V.P.); (M.C.); (M.S.)
| | - Marcus Czabanka
- Department of Neurosurgery, Goethe University Hospital, 60528 Frankfurt, Germany; (F.K.); (V.P.); (M.C.); (M.S.)
| | - Matthias Setzer
- Department of Neurosurgery, Goethe University Hospital, 60528 Frankfurt, Germany; (F.K.); (V.P.); (M.C.); (M.S.)
| | - Thomas Freiman
- Department of Neurosurgery, University Medicine of Rostock, 18057 Rostock, Germany; (F.G.); (D.D.); (S.-Y.W.); (T.F.)
| | - Bedjan Behmanesh
- Department of Neurosurgery, Goethe University Hospital, 60528 Frankfurt, Germany; (F.K.); (V.P.); (M.C.); (M.S.)
- Department of Neurosurgery, University Medicine of Rostock, 18057 Rostock, Germany; (F.G.); (D.D.); (S.-Y.W.); (T.F.)
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3
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 186] [Impact Index Per Article: 186.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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4
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Vertebral Osteomyelitis and Infective Endocarditis Co-Infection. J Clin Med 2022; 11:jcm11082266. [PMID: 35456361 PMCID: PMC9030611 DOI: 10.3390/jcm11082266] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 01/05/2023] Open
Abstract
Many cases of vertebral osteomyelitis (VO) and infective endocarditis (IE) co-infection have been reported, and it has been recognized that attention should be paid to the possibility of both diseases co-existing during diagnosis and treatment. However, the incidence, clinical status, and outcomes of IE in patients with VO remain unclear. For this study, the eligibility criteria for patient recruitment included all cases of VO at the five medical university hospitals. Patients with a history of spinal surgery were excluded from this study. Echocardiography was routinely performed for all patients with VO. IE was diagnosed according to the modified Duke criteria for definite endocarditis. We analyzed demographic data, underlying conditions, clinical features, laboratory data, echocardiography, radiologic images, treatments, and outcomes. VO was diagnosed in 59 patients and IE was diagnosed in seven patients (12%). There were no significant differences in the clinical features, microorganisms, or radiographic status between the VO-IE co-infection and VO-only groups. In this study, using routine echocardiography for VO, the IE prevalence was 12%. The lack of specific clinical features and laboratory findings may hamper the diagnosis of IE. Therefore, clinicians are always required to suspect IE in patients with VO.
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5
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Del Pace S, Scheggi V, Virgili G, Caciolli S, Olivotto I, Zoppetti N, Merilli I, Ceschia N, Andrei V, Alterini B, Stefàno PL, Marchionni N. Endocarditis with spondylodiscitis: clinical characteristics and prognosis. BMC Cardiovasc Disord 2021; 21:186. [PMID: 33858337 PMCID: PMC8051097 DOI: 10.1186/s12872-021-01991-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 04/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background The association of infective endocarditis (IE) with spondylodiscitis (SD) was first reported in 1965, but few data are available about this issue. This study aimed to evaluate the prevalence of SD in patients with IE, and to determine the clinical features and the prognostic impact of this association.
Methods We retrospectively analysed 363 consecutive patients admitted to our Department with non-device-related IE. Radiologically confirmed SD was revealed in 29 patients (8%). Long-term follow-up (average: 3 years) was obtained by structured telephone interviews; in 95 cases (13 of whom had been affected by SD), follow-up echocardiographic evaluation was also available.
Results At univariable analysis, the combination of IE with SD was associated with male gender (p = 0.017), diabetes (p = 0.028), drug abuse (p = 0.009), Streptococcus Viridans (p = 0.009) and Enterococcus (p = 0.015) infections. At multivariable analysis, all these factors independently correlated with presence of SD in patients with IE. Mortality was similar in patients with and without SD. IE relapses at 3 years were associated with the presence of SD (p = 0.003), Staphylococcus aureus infection (p < 0.001), and drug abuse (p < 0.001) but, at multivariable analysis, only drug abuse was an independent predictor of IE relapses (p < 0.001; HR 6.8, 95% CI 1.6–29). At echocardiographic follow-up, SD was not associated with worsening left ventricular systolic function or valvular dysfunction. Conclusions The association of IE with SD is not rare. Hence, patients with IE should be screened for metastatic infection of the vertebral column, especially if they have risk factors for it. However, SD does not appear to worsen the prognosis of patients with IE, either in-hospital or long-term.
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Affiliation(s)
- Stefano Del Pace
- Division of General Cardiology, University of Florence, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Valentina Scheggi
- Cardiovascular and Perioperative Medicine, University of Florence, Florence, Italy. .,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Giacomo Virgili
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Sabina Caciolli
- Division of General Cardiology, University of Florence, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Iacopo Olivotto
- Division of General Cardiology, University of Florence, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Nicola Zoppetti
- Institute of Applied Physics "Nello Carrara" (IFAC), National Research Council, Sesto Fiorentino, Italy
| | - Irene Merilli
- Cardiovascular and Perioperative Medicine, University of Florence, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Nicole Ceschia
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Valentina Andrei
- Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Bruno Alterini
- Cardiovascular and Perioperative Medicine, University of Florence, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Pier Luigi Stefàno
- Cardiac Surgery, University of Florence, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Niccolò Marchionni
- Division of General Cardiology, University of Florence, Florence, Italy.,Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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Anis HK, Miller EM, George J, Shrestha NK, Klika AK, Kamath AF, Babic M, Higuera CA. Incidence and Characteristics of Osteoarticular Infections in Patients With Infective Endocarditis. Orthopedics 2020; 43:24-29. [PMID: 31693740 DOI: 10.3928/01477447-20191031-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/12/2019] [Indexed: 02/03/2023]
Abstract
Osteoarticular infections (OAIs) in the setting of infective endocarditis (IE) are uncommon. Although morbidity and mortality have been widely studied, details of the characteristics of patients with concurrent IE and OAI are limited. Therefore, the purpose of this study was to determine the (1) incidence, (2) mortality, (3) clinical features, and (4) microbiological profiles of OAIs in the setting of IE. A retrospective review was conducted of 1280 IE cases at a large academic institution between 2009 and 2015. Patients were categorized according to the following OAI types: spondylodiskitis, large joint septic arthritis, other site infections, or multiple affected joints. Inpatient mortality rates, clinical findings, and microbiological characteristics were compared between OAI types. Overall, the incidence of OAI among IE patients was 6.8% (n=87). The in-hospital mortality rate was 9.2% (n=8) and was not significantly associated with OAI type (P=.801). Eighteen patients had multiple affected joints resulting in a total of 114 infected sites. Of these, 39% (n=44) were spondylodiskitis, 29% (n=33) were large joint septic arthritis, and 32% (n=37) were infections of smaller joints. Back pain was most common among patients with spondylodiskitis (P<.001), whereas fever and general fatigue were most common with septic arthritis (P<.001). Of the available bone/ joint cultures, 69% were positive. Overall, Staphylococcus aureus was the most common IE pathogen in patients with both IE and OAI (63%). Clinicians should maintain a high suspicion for OAI in patients with IE caused by Staphylococcus aureus, particularly spondylodiskitis among those presenting with back pain. [Orthopedics 2020; 43(1):24-29.].
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7
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Talipova IZ, Zholdin BK, Seitmagambetova SA, Kurmanalina GL, Kushimova DE. Infectious endocarditis сomplicated spondilodiscitis. BULLETIN OF SIBERIAN MEDICINE 2018. [DOI: 10.20538/1682-0363-2018-4-287-293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This publication presents a clinical case of infectious endocarditis in an adult male aged 60, with manifestation of the disease in the form of spondilodiscitis. The presented observation demonstrates the development of onset of infectious endocarditis of bacterial spondylodiscitis in the adult patient. For a long time the patient’s intensive pain in the lumbar region could not be connected with infective endocarditis. According to the results of the examination the changes in the spine were not evaluated as an onset of IE. Dynamic observation and control MRT study allowed for the conclusion about bacterial spondilodiscitis in our patient with IE and to connect these two processes. In such clinical cases, MRT of the spine or positron emission tomography combined with computed tomography using a radiopharmaceutical 18F-fluorodeoxyglucose (F-FDG- PET / CT) of the whole body is recommended. In the case of a specific spondilodiscitis, the continuation of antibacterial therapy is determined by signs of inflammatory activity on F-FDG-PET / CT or MRT of the spine.
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Affiliation(s)
| | - B. K. Zholdin
- West Kazakhstan Marat Ospanov State Medical University
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8
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Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075-3128. [PMID: 26320109 DOI: 10.1093/eurheartj/ehv319] [Citation(s) in RCA: 3126] [Impact Index Per Article: 347.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
MESH Headings
- Acute Kidney Injury/diagnosis
- Acute Kidney Injury/therapy
- Ambulatory Care
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/therapy
- Anti-Bacterial Agents/therapeutic use
- Antibiotic Prophylaxis
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Clinical Laboratory Techniques
- Critical Care
- Cross Infection/etiology
- Dentistry, Operative
- Diagnostic Imaging/methods
- Embolism/diagnosis
- Embolism/therapy
- Endocarditis/diagnosis
- Endocarditis/therapy
- Endocarditis, Non-Infective/diagnosis
- Endocarditis, Non-Infective/therapy
- Female
- Fibrinolytic Agents/therapeutic use
- Heart Defects, Congenital
- Heart Failure/diagnosis
- Heart Failure/therapy
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Long-Term Care
- Microbiological Techniques
- Musculoskeletal Diseases/diagnosis
- Musculoskeletal Diseases/microbiology
- Musculoskeletal Diseases/therapy
- Myocarditis/diagnosis
- Myocarditis/therapy
- Neoplasms/complications
- Nervous System Diseases/diagnosis
- Nervous System Diseases/microbiology
- Nervous System Diseases/therapy
- Patient Care Team
- Pericarditis/diagnosis
- Pericarditis/therapy
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prognosis
- Prosthesis-Related Infections/diagnosis
- Prosthesis-Related Infections/therapy
- Recurrence
- Risk Assessment
- Risk Factors
- Splenic Diseases/diagnosis
- Splenic Diseases/therapy
- Thoracic Surgical Procedures
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9
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The impact of bacteremia on the outcome of bone infections. Med Mal Infect 2014; 44:380-6. [PMID: 25169941 DOI: 10.1016/j.medmal.2014.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/02/2014] [Accepted: 07/22/2014] [Indexed: 11/21/2022]
Abstract
UNLABELLED We have used a medical database to analyze our activity since 2005. We observed a frequent association between bone and joint infection (BI) and bacteremia. Our aim was to characterize patients with BI and bacteremia, and focus on the outcome. PATIENTS AND METHOD Our database includes the prospective recording of 28 characteristics of all hospitalized patients, including diagnosis, comorbid conditions, microbiological data, therapy, and outcome. We selected patients presenting with BI in this database, from July 2005 to December 2012. Fever before blood culture was retrospectively documented from the patient's chart. Chronic BI was defined as a disease lasting more than 1 month. An unfavorable outcome was defined by the need for intensive care or death. RESULTS Six hundred and thirty-two patients presented with BI and 125 with bacteremia (19.8%). We used a stepwise logistic regression analysis and determined that bacteremia was associated with vertebral osteomyelitis, OR, 3.97, P<0.001; alcohol abuse, OR, 2.51, P=0.010; fever, OR, 2.43, P<0.001; neurological and/or psychiatric diseases, OR, 2.41, P ≤ 0.001; and Staphylococcus aureus infection, OR, 2.32, P<0.001. The outcome was unfavorable in 23 cases (3.6%), associated with bacteremia, OR, 8.00, P<0.001, age> 60 years, OR, 4.78, P=0.018, and S. aureus infection, OR, 3.96, P=0.010. No single comorbid condition was significantly associated with an unfavorable outcome. CONCLUSION Bacteremia occurred in nearly 20% of the patients presenting with BI, and was associated with identifiable comorbid conditions; it was the main risk factor for an unfavorable outcome.
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Akiyama T, Chikuda H, Yasunaga H, Horiguchi H, Fushimi K, Saita K. Incidence and risk factors for mortality of vertebral osteomyelitis: a retrospective analysis using the Japanese diagnosis procedure combination database. BMJ Open 2013; 3:bmjopen-2012-002412. [PMID: 23533214 PMCID: PMC3612742 DOI: 10.1136/bmjopen-2012-002412] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To examine the incidence of vertebral osteomyelitis (VO) and the clinical features of VO focusing on risk factors for death using a Japanese nationwide administrative database. DESIGN Retrospective observational study. SETTING Hospitals adopting the Diagnosis Procedure Combination system during 2007-2010. PARTICIPANTS We identified 7118 patients who were diagnosed with VO (International Classification of Diseases, 10th Revision codes: A18.0, M46.4, M46.5, M46.8, M46.9, M48.9 and M49.3, checked with the detailed diagnoses in each case and all other codes indicating the presence of a specific infection) and hospitalised between July and December, 2007-2010, using the Japanese Diagnosis Procedure Combination database. MAIN OUTCOME MEASURES The annual incidence of VO was estimated. Logistic regression analysis was performed to analyse factors affecting in-hospital mortality in the VO patients. Dependent variables included patient characteristics (age, sex and comorbidities), procedures (haemodialysis and surgery) and hospital factors (type of hospital and hospital volume). RESULTS Overall, 58.9% of eligible patients were men and the average age was 69.2 years. The estimated incidence of VO increased from 5.3/100 000 population per year in 2007 to 7.4/100 000 population per year in 2010. In-hospital mortality was 6%. There was a linear trend between higher rates of in-hospital mortality and greater age. A higher rate of in-hospital mortality was significantly associated with haemodialysis use (ORs, 10.56 (95% CI 8.12 to 13.74)), diabetes (2.37 (1.89 to 2.98)), liver cirrhosis (2.63 (1.49 to 4.63)), malignancy (2.68, (2.10 to 3.42)) and infective endocarditis (3.19 (1.80 to 5.65)). CONCLUSIONS Our study demonstrates an increasing incidence of VO, and defines risk factors for death with a nationwide database. Several comorbidities were significantly associated with higher rates of in-hospital death in VO patients.
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Affiliation(s)
- Toru Akiyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromasa Horiguchi
- Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Kazuo Saita
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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