Background: Bacterial native vertebral osteomyelitis (NVO) can present diagnostic and therapeutic challenges leading to high levels of morbidity and mortality. To inform strategies aimed at improving outcomes in these patients, data are needed on the current aetiology, diagnostic interventions, management and risk factors for treatment failure. Methods: This was a retrospective, multicentre, observational cohort study of adult patients with bacterial NVO across the UK between 1st January 2015 and 31st December 2016. Infectious Disease Society of America (IDSA) guideline standards were selected and used to audit practice relating to the management of these patients. Results: A total of 286 patients were included from 40 hospitals. An organism was identified in 61% of cases by blood culture or biopsy. Of these, 51% were due to Staphylococcus aureus and 12% were due to Gram-negative bacteria. When performed, biopsy obtained a microbiological diagnosis in 50% of cases. Nearly 10% of patients required admission to an Intensive Care Unit, 20% were re-admitted to hospital, 56% experienced complications and 6% died within 90 days. Higher Charlson comorbidity index (CCI) was significantly associated with treatment failure at one month (p = 0.004). Conclusions: This study identified opportunities to improve UK practice in the investigation and management of bacterial NVO. The range of organisms isolated supports the use of diagnostic biopsy where blood cultures are non-diagnostic, to guide antimicrobial therapy and strive to avoid treatment failure or complications. This study shows a clear need for antibiotic guidelines to reflect the current aetiology of NVO and authors support the creation of a formal registry.
Bibliographical noteFunding Information:
This work used data from patients collected by the NHS staff and medical students listed below. Without their contributions this work would not have been possible. Aberdeen – Aberdeen Royal Infirmary. Mr George Patrick Ashcroft, Consultant Orthopaedic Surgeon. Dr Vhairi Bateman, Consultant in Infectious Diseases and Medical Microbiology. Zheng Siying Cindy, Medical student. Niti Athavle, Medical student. Barts Health NHS Trust. Kathryn O'Brien, Medical student. Matthew Barrett, Medical student. Florence Wilkinson, Medical student. Belfast – Royal Victoria Hospital. Mr Niall Eames, Orthopaedic Surgeon. Mr Rakesh Dhokia, Specialty Registrar in Trauma and Orthopaedics. Birmingham – Heart of England NHS Trust. Dr Angela Minassian, Consultant in Infectious Diseases. University Hospitals Birmingham NHS Trust. Dr Paul McWhinney, Consultant in Infectious Diseases. Bristol – University Hospital Bristol. Dr Martin Williams, Consultant in Infection and Microbiology. Omdesola Awokoya, Medical student. Leona Richards, Medical student. Cardiff – University Hospital Wales. Dr Anil Kumar, Consultant in Acute Medicine. Claudia Zeicu, Medical student. Derby – Derby Teaching Hospitals Foundation Trust. Mr Rajendra Bommireddy, Consultant Orthopaedic spinal surgeon. East Kent Hospitals University NHS Foundation Trust. Dr Srinivasulu Reddy, Consultant Microbiologist, East Kent University Hospitals NHS Foundation Trust. Edinburgh – Western General Hospital. William Broadhurst, Medical student. Glasgow – Queen Elizabeth University Hospital. Mr Nassir Hussain, Consultant Orthopaedic Surgeon. Andrew Croall, Medical student. Andrew Wilkinson, Medical student. Jacob Mewse, Medical student. James Irvine, Medical student. Imperial College Healthcare NHS Trust. Imogen John, Medical student. Jake Symington, Medical student. Lancaster – Royal Lancaster Infirmary. Dr Monika Pasztor, Consultant. Auday Marwaha, Medical student. Zuzanna Nowinka, Medical student. Ege Arioglu, Medical student. Dominic Beith, Medical student. Aditi Ranjan, Medical student. Leeds – Leeds Teaching Hospitals NHS Trust. Aimee Lloyd, Medical student. Leicester – University Hospitals Leicester. Mr Jason Braybrooke, Consultant Orthopaedic Spinal Surgeon. Elsie Hunter, Medical student. Abina Dharmaratnam, Medical student. Chris Wilkinson, Medical student. National Student Association of Medical Research. Eloisa MacLachlan, Medical student. Kathryn O'Brien, Medical student. Reem Abdelgalil, Medical student. Serena Banh, Medical student. Newcastle – Royal Victoria Infirmary. Lauren Medwell, Medical student. North Middlesex University Hospital. Dr Daniel Bell, Consultant. Nottingham – Queens Medical Centre. Mr Guiseppe Morassi, Consultant Spinal Surgeon. Adam Graham, Medical student. Delan Sivandarajah, Medical student. Oxford – Oxford University Hospitals NHS Trust. Dr Matthew Scarborough, Consultant in Infectious Diseases and Microbiology. Plymouth – Plymouth Hospitals NHS Trust. Dr James Greig, Consultant Microbiologist. Royal Free Hospital. Dr Susan Hopkins, Consultant in Infectious Diseases and Microbiology. Stephanie Harris, Medical student. Sheffield – Sheffield Teaching Hospitals. Dr Katharine Cartwright, Consultant in Infectious Diseases. Shrewsbury and Telford. Dr Yasar Hussain, Consultant Clinical Scientist in Medical Microbiology. Worcestershire -Worcestershire Royal Hospital. Sophie Turton, Medical student.
© 2021 The Author(s)