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Petri F, Mahmoud OK, Zein SE, Alavi SMA, Passerini M, Diehn FE, Verdoorn JT, Tande AJ, Nassr A, Freedman BA, Murad MH, Berbari EF. Wide variability of the definitions used for native vertebral osteomyelitis: walking the path for a unified diagnostic framework with a meta-epidemiological approach. Spine J 2024:S1529-9430(24)01047-7. [PMID: 39349257 DOI: 10.1016/j.spinee.2024.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/19/2024] [Accepted: 09/14/2024] [Indexed: 10/02/2024]
Abstract
BACKGROUND CONTEXT Native Vertebral Osteomyelitis (NVO) has seen a rise in incidence, yet clinical outcomes remain poor with high relapse rates and significant long-term sequelae. The 2015 IDSA Clinical Practice Guidelines initiated a surge in scholarly activity on NVO, revealing a patchwork of definitions and numerous synonyms used interchangeably for this syndrome. PURPOSE To systematically summarize these definitions, evaluate their content, distribution over time, and thematic clustering. STUDY DESIGN/SETTING Meta-epidemiological study with a systematic review of definitions. PATIENTS SAMPLE An extensive search of multiple databases was conducted, targeting trials and cohort studies dating from 2005 to present, providing a definition for NVO and its synonyms. OUTCOME MEASURES Analysis of the diagnostic criteria that composed the definitions and the breaking up of the definitions in the possible combinations of diagnostic criteria. METHODS We pursued a thematic synthesis of the published definitions with Boolean logic, yielding single or multiple definitions per included study. Using 8 predefined diagnostic criteria, we standardized definitions, focusing on the minimum necessary combinations used. Definition components were visualized using Sankey diagrams. RESULTS The literature search identified 8,460 references, leading to 171 studies reporting on 21,963 patients. Of these, 91.2% were retrospective, 7.6% prospective, and 1.2% RCTs. Most definitions originated from authors, with 29.2% referencing sources. We identified 92 unique combinations of diagnostic criteria across the literature. Thirteen main patterns emerged, with the most common being clinical features with imaging, followed by clinical features combined with imaging and microbiology, and lastly, imaging paired with microbiology. CONCLUSIONS Our findings underscore the need for a collaborative effort to develop standardized diagnostic criteria. We advocate for a future Delphi consensus among experts to establish a unified diagnostic framework for NVO, emphasizing the core components of clinical features and MRI while incorporating microbiological and histopathological insights to improve both patient outcomes and research advancements.
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Affiliation(s)
- Francesco Petri
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, 55905, MN, USA; Department of Infectious Diseases, ASST Fatebenefratelli Sacco, "L. Sacco" University Hospital, Milan, 20157, Italy.
| | - Omar K Mahmoud
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, 55905, MN, USA
| | - Said El Zein
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, 55905, MN, USA
| | | | - Matteo Passerini
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, "L. Sacco" University Hospital, Milan, 20157, Italy; Department of Pathophysiology and Transplantation, University of Milano, Milan, 20122, Italy
| | - Felix E Diehn
- Department of Radiology, Mayo Clinic, Rochester, 55905, MN, USA
| | | | - Aaron J Tande
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, 55905, MN, USA
| | - Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, 55905, MN, USA
| | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, 55905, MN, USA
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, 55905, MN, USA; Evidence-based Practice Center, Mayo Clinic, Rochester, 55905, MN, USA
| | - Elie F Berbari
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, 55905, MN, USA.
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Cadiou S, Tuil R, Le Goff B, Hoppé E, Mulleman D, Langbour C, Le Pabic E, Charret L, Cormier H, Lecomte R, Arvieux C, Guggenbuhl P. Septic arthritis of the facet joint is also a severe vertebral infection: A multicenter retrospective study of 65 patients. Joint Bone Spine 2024; 91:105703. [PMID: 38336272 DOI: 10.1016/j.jbspin.2024.105703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Septic arthritis of the Facet Joints (SAFJ) is a rare condition. Little data has been published on the subject. We aimed to describe the clinical, biological and imagery presentations, as well as the course of this rare infection. METHODS We included patients hospitalized between January 1st, 2016 and December 31th, 2019, in the Departments of Infectious Diseases or Rheumatology in 5 French centres in the CRIOGO network. We defined septic arthritis according to Newman's criteria and facet joint arthritis using imagery. RESULTS Sixty-five patients were included, predominantly males (64.6%), with a mean age of 68.1 years. The mean time to diagnosis was 25.0 days. The principal symptoms at diagnosis were acute back pain (95.2%) and fever (76.9%). Neurological symptoms were present for 60.7% of the patients, including 16.4% motor deficit or cauda equina syndrome. SAFJ was located on the lumbosacral spine (73.4%) and was rarely multifocal (4.7%). Bacteriological identification was performed by blood cultures in 84.4% of the cases, and the pathogen was mainly Staphylococcus aureus (49.2%). Infective endocarditis was present for 26.9% of patients assessed by echocardiography. On MRI, soft tissue abscess or inflammation, epiduritis and epidural abscess were present in 87.1%, 66.7% and 33.9% of cases, and the pathogen was significantly more frequently Staphylococcus aureus. Mortality reached 9.2%, 18.5% and 23% at one, two, and three years respectively. CONCLUSION SAFJ is a rare but severe disease. Microbiological diagnosis is primarily made on blood cultures, and S. Aureus was the main pathogen. Our results highlight the fact that SAFJ is associated with high morbidity and mortality, and with infective endocarditis.
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Affiliation(s)
- Simon Cadiou
- Department of Rheumatology, Rennes University Hospital, Rennes, France.
| | - Rachel Tuil
- Department of Rheumatology, Rennes University Hospital, Rennes, France; Rennes University, Faculty of Medicine, Rennes, France
| | - Benoît Le Goff
- Regenerative Medicine and Skeleton, RMeS, UMR 1229, Oniris, Inserm, Nantes university, Nantes, France; Department of Rheumatology, Nantes University Hospital, Nantes, France
| | - Emmanuel Hoppé
- Department of Rheumatology, Angers University Hospital, Angers, France
| | - Denis Mulleman
- Department of Rheumatology, Tours University Hospital, University of Tours, Tours, France
| | - Camille Langbour
- Department of Rheumatology, Tours University Hospital, University of Tours, Tours, France
| | - Estelle Le Pabic
- Inserm, CIC UMR 1414, Rennes University Hospital, Rennes University, Rennes, France
| | - Laurie Charret
- Rheumatology Department, Hospital of Vendée, La Roche-Sur-Yon, France
| | - Helene Cormier
- Department of Infectious Diseases, Angers University Hospital, Angers, France
| | - Raphael Lecomte
- Department of Infectious Diseases, Centre d'Investigation Clinique 1413, Inserm, University Hospital of Nantes, Nantes, France
| | - Cédric Arvieux
- Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France
| | - Pascal Guggenbuhl
- Department of Rheumatology, Rennes University Hospital, Rennes, France; University of Rennes, Inserm, INRAE, CHU of Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), Rennes, France
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Kitov B, Kehayov I, Davarski A, Kitova T. Letter to the Editor: Does Operative Management of Epidural Abscesses Increase Healthcare Expenditures up to 1 Year After Treatment? Clin Orthop Relat Res 2023; 481:1858-1859. [PMID: 37466440 PMCID: PMC10427034 DOI: 10.1097/corr.0000000000002789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/29/2023] [Indexed: 07/20/2023]
Affiliation(s)
- Borislav Kitov
- Professor, Clinic of Neurosurgery, St. George University Hospital, Plovdiv, Bulgaria
| | - Ivo Kehayov
- Associate Professor, Department of Neurosurgery, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Atanas Davarski
- Assistant Professor, Department of Neurosurgery, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Tanya Kitova
- Professor, Department of Anatomy, Histology and Embryology, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
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Meyer-Schwickerath C, Jochimsen D, Jung N. [Update bone infections]. Dtsch Med Wochenschr 2023; 148:313-317. [PMID: 36878230 DOI: 10.1055/a-1853-4777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Bone and joint infections are becoming of great concern in an elderly population with growing numbers of prosthetic joints and comorbidities. This paper summarizes recently published literature on periprosthetic joint infections, vertebral osteomyelitis and diabetic foot infections. According to a new study, in the presence of a hematogenous periprosthetic infection and other inserted joint prostheses that are unremarkable on clinical examination, further invasive or imaging diagnostics may not be necessary. Periprosthetic infections that occur late (> 3 months after joint installation) have a worse outcome. New studies tried to identify factors when prosthesis preservation might still be an option. A new randomized landmark trial from France failed to show non-inferiority for 6 versus 12 weeks of therapy length. Thus, it can be assumed that this will currently become the standard therapy length for all surgical modalities (retention or replacement). Vertebral osteomyelitis is a rather rare bone infection, but the incidence has continued to rise sharply in recent years. A retrospective study from Korea provides information on the distribution of pathogens in different age groups and with selected comorbidities; this could help in the selection of an empiric therapy when pathogen identification is not successful before starting the treatment. The guidelines by the "International Working Group on the Diabetic Foot (IWGDF)" have been updated with a slightly different classification. New practice recommendations of the German society of diabetology emphasize an early interdisciplinary interprofessional management. Empirical therapy continues to be based on the severity of the infection and other risk factors (such as previous therapies or ischemia). Microbiological diagnosis from tissue samples is described as superior to smears. According to a randomized pilot study, 3 weeks therapy length for osteomyelitis after debridement appears to be noninferior to 6 weeks.
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Affiliation(s)
| | - Dorothee Jochimsen
- Klinik I für Innere Medizin, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Köln
| | - Norma Jung
- Klinik I für Innere Medizin, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Köln
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