Article review:   Bhavan KP, Marschall J, Olsen MA, et al:  The Epidemiology of hematogenous vertebral osteomyelitis: a cohort study in a tertiary care hospital.  BMC Infectious Diseases, 2010: 10: 158doi: 10.1186/1471-2334-10-158  (Published 7-7-2010).

Dr. Cierny’s comments:  this article describes the epidemiology and early management of hematogenous vertebral osteomyelitis (anatomic types I and IV) in 70 patients over a 2-year period at Barnes Hospital in Missouri (a retrospective, cohort review).  A microbiological diagnosis was made in only two-thirds the cases.  S. aureus was the most common causative organism.

Results – The mean age was 59.7 years with 54% male. Predisposing factors included: B-hosts with diabetes (43%) or renal insufficiency (24%); in the 30 days prior to admission, an indwelling catheter (30%), bacteremia (19%) or skin/soft tissue infection (17%).  Back pain was the most common symptom (87%), followed by weakness (56%) and fever (46%); seven patients presented with paraplegia.  48% had a normal WBC but 95-98% had either an elevated ESR or CRP. 

The lumbar spine was the most common anatomic location (47%): thoracic (29%); cervical (24%).  Among the 46 (66%) patients with a microbiological diagnosis, the most common organisms were MSSA (33%) and MRSA (22%).  Among the 44 (63%) patients who had a diagnostic biopsy, open biopsy was more likely to result in pathogen recovery [14 (93%) of 15 with open biopsy vs. 14 (48%) of 29 with needle biopsy; p=0.003].   Surgery was required during the initial hospitalization in 23% of patients: decompression laminectomy 14%), laminectomy /fusion (7%) and corporectomy (1%).  Treatment outcomes were not included.